ITK AugSept 2017 - Issue 55 by Gold Cross Products & Services

ISSUE #55 : AUGUST/SEPTEMBER 2017

P R A C T I C A L I N F O R M AT I O N F O R T O D AY ’ S CO M M U N I T Y P H A R M A C I S T • PHARMACY TECHNOLOGY & INNOVATION

IN THE KNOW

• PRACTICE READY: SHINGLES • ORAL CARE: THE ROLE OF SUGAR & DIET

• PROBIOTICS: A NOVEL THERAPY FOR ANXIETY AND DEPRESSION • CPD - AN OVERVIEW OF DIABETESRELATED ORAL COMPLICATIONS

LEAD THE CHANGE

WITH MAXIGESIC®

CONSUMERS ARE LOOKING TO YOU FOR STRONG PAIN RELIEF ALTERNATIVES TO CODEINE

MAKE THE SWITCH

TO MAXIGESIC

ÂŽ

The only paracetamol/ibuprofen combination that provides better pain relief than paracetamol or ibuprofen alone1,2 The only paracetamol/ibuprofen combination analgesic clinically proven to reduce pain levels by at least 32% more than a full daily OTC dose of either paracetamol or ibuprofen alone. 1,2 A unique patented combination of paracetamol 500mg and ibuprofen 150mg with no generic alternatives. Provides a maximum daily dose of 8 tablets (1-2 tablets every 6 hours), if required, compared to 3 tablets daily (1 tablet every 8 hours) for other paracetamol/ibuprofen combinations. The only combination analgesic that provides the maximum daily OTC dosage of paracetamol 4000mg and ibuprofen 1200mg, if required.*

MORE EFFECTIVE

THAN PARACETAMOL1

MORE EFFECTIVE

THAN IBUPROFEN 1

Hartley Atkinson Scientist behind Maxigesic

MAKE THE SWITCH

TO MAXIGESIC®

Codeine rescheduling provides an opportunity to lead the change with your consumers, by proactively recommending alternative pharmacy OTC analgesics before the implementation date, 1 February 2018.

Retain your codeine customer base by switching them to MAXIGESIC®, the only paracetamol/ ibuprofen combination proven to provide superior analgesic efficacy than either a full OTC dose paracetamol or ibuprofen alone.1,2

CONSUMERS ARE LOOKING TO YOU FOR ALTERNATIVES An independent survey of 100 adult consumers, conducted by MedPanel LLC in January 20173, concluded that: • 70% would source an alternative analgesic from their pharmacy

• 55% would ask their pharmacist as a source of information in selecting an alternative analgesic

The results from the study reinforces the critical role pharmacists play in offering advice to consumers.

Important features consumers would look for in an alternative pharmacy analgesic included:

Strength

80%

Value for money

46%

Endorsed by Pharmacy Guild

23%

Please review the full Product Information before recommending at www.maxigesic.com.au References: 1. Merry, A. F., Gibbs, R. D., Edwards, J., Ting, G. S., Frampton, C., Davies, E. and Anderson, B. J. (2010). “Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial” British Journal of Anaesthesia 104(1): 80-88. Result achieved in a trial of post-operative pain relief after removal of 1–4 wisdom teeth using MAXIGESIC® compared with paracetamol 4000mg or ibuprofen 1200mg alone per day in four divided doses. 2. Mehlisch, D. R., Aspley, S., Daniels, S. E., & Bandy, D. P. (2010). Comparison of the analgesic efficacy of concurrent ibuprofen and paracetamol with ibuprofen or paracetamol alone in the management of moderate to severe acute postoperative dental pain in adolescents and adults: A randomized, double-blind, placebo-controlled, parallel-group, single-dose, two-center, modified factorial study. Clinical Therapeutics, 32(5), 882–895. doi:10.1016/j.clinthera.2010.04.022. 3. January 2017 telephone survey of 100 Australian residents who had purchased OTC codeine products in the last 6 months, conducted by MedPanel LLC. The sample error was estimated to be +/- 9.8%.

*2 tablets of MAXIGESIC taken every 6 hours over a 24 hour period (8 tablets maximum) MAXIGESIC® film coated tablets (paracetamol 500mg and ibuprofen 150mg) are for the temporary relief of pain and reduction of fever. The usual dosage for adults and children over 12 years is 1-2 tablets taken every 6 hours with a full glass of water, as required, up to a maximum of 8 tablets in 24 hours. Patients should not take more than 8 tablets in a 24 hour period. Incorrect use can be harmful. Do not use in children under 12 years or if patients have kidney disease. Do not use if patients have asthma or a stomach ulcer. Do not combine with any other paracetamol or ibuprofen containing medicines. Patent No. 2005260243.

GET BETTER PAIN RELIEF than paracetamol or ibuprofen alone

PROVEN PAIN RELIEF

MAXIGESIC IS DIFFERENT

135 Patients

A double blind, parallel group study of 135 patients undergoing removal of between 1 & 4 wisdom teeth: = 4000mg / day

Ibuprofen (150mg) 2 tablets 4 times a day

= 1200mg / day

MAXIGESIC 2 tablets 4 times a day

= Paracetamol 4000mg / day Ibuprofen 1200mg / day

•

A unique patented combination of paracetamol 500mg and ibuprofen 150mg with no generic alternatives, that can’t be replicated by combining individual OTC products available in grocery.

•

Provides a maximum daily dose of 8 tablets (1–2 tablets every 6 hours), if required, compared to 3 tablets daily (1 tablet every 8 hours) for other paracetamol/ibuprofen combinations.

•

MAXIGESIC delivers 2.7 times more paracetamol and 2 times more ibuprofen than other paracetamol/ibuprofen combination analgesics at the maximum recommended daily OTC dose, if required.*

•

The only combination analgesic that provides the maximum daily OTC dosage of paracetamol 4000mg and ibuprofen 1200mg, if required.*

•

MAXIGESIC is a Down Under success story that is going global – now licensed in 112 countries around the world.

PAIN SCORES AT REST AFTER DENTAL SURGERY PAIN SCORES AT REST AFTER DENTAL SURGERY HIGH

Paracetamol# Ibuprofen#

MAXIGESIC

20 15

The red line shows MAXIGESIC® provides better pain relief (less pain) than Paracetamol or Ibuprofen alone

LOW

LOW VAS = LESS PAIN

40 35

Pain intensity (VAS)

HIGH VAS = MORE PAIN

The only paracetamol/ibuprofen combination analgesic clinically proven to reduce pain levels by at least 32% more than a full daily OTC dose of either paracetamol or ibuprofen alone. 1,2 » One tablet of any paracetamol 500mg/ibuprofen 200mg combination is not statistically more effective than 400mg of Ibuprofen2.

Paracetamol (500g) 2 tablets 4 times a day

•

Ref 1

Ibuprofen 1200mg/day or Paracetamol 4000mg/day in four divided doses

0 4

Hours after surgery MAXIGESIC vs Paracetamol MAXIGESIC has 32.2% lower pain scores** (p=0.007)

MAXIGESIC vs Ibuprofen

MAXIGESIC has 35.8% lower pain scores** (p=0.003)

Active medicine (per single dose)

MAXIGESIC 500mg + 150mg

Other combinations 500mg + 200mg

500–1000mg paracetamol 150–300mg ibuprofen

500mg paracetamol 200mg ibuprofen

Max. daily dose:

8 tablets

3 tablets

Dose frequency

Every 6 hours, 4x daily

Every 8 hours, 3x daily

Max. paracetamol (per day)

4000mg 2.7 x more (+167%)

1500mg

Max. ibuprofen (per day)

1200mg 2.0 x more (+100%)

600mg

Max. total medication (per day)

5200mg 2.5 x more (+148%)

2100mg

Proud sponsor of the ** Pain levels are indicated on a Visual Analogue Scale (VAS) measured in millimetres and are expressed as the mean time adjusted VAS pain scores 48 hours post-op at rest. Ref 1. Result achieved in a trial of post-operative pain relief after removal of 1 – 4 wisdom teeth using 2 tablets MAXIGESIC compared with paracetamol 1000mg or ibuprofen 300mg alone 4 times a day (Paracetamol 4000mg or Ibuprofen 1200mg per day)

AFT Pharmaceuticals Pty Ltd, Sydney ABN 29105636413 WEBSITE www.aftpharm.com FREE PHONE 1800 2387 4276 FREE FAX 1800 041 026 EMAIL customer.service@aftpharm.com

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of the Year

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CONTENTS

AFTER HOURS 55 PARRTJIMA

BUSINESS 18 PHARMACY TECHNOLOGY & INNOVATION

SEAN TUNNY

26 IS NOW THE TIME TO AUTOMATE MY PHARMACY?

Editor, Gold Cross Products & Services Pty Ltd

30 PHARMACY ALLIANCE PARTNER PROGRAM: WE DO THE HARD WORK FOR YOU

THE VALUE OF A BRAND In October 2014, ITK presented to pharmacists a unique feature Gold Cross booklet, reinforcing the value of the Gold Cross logo and a brand that unifies pharmacy. So, what is brand value or equity?

32 FIVE COMMON LEASING MISTAKES

36 BLAME IT ON THE RAIN: WET WEATHER BOOSTS SALES FOR ASTHMA AND ALLERGY TREATMENTS 46 WE’RE ALL IN THIS TOGETHER

Well, who do you think has the most powerful and valuable brand in the world? In 2014, we identified that Apple held this privileged position. In 2017, Google has assumed the position as the leading company with the greatest brand value, worth $109.5 billion. So what is brand value? A brand includes the name, logo, image, and overall perceptions that identify the product, service and owner of the brand in the minds of customers.

HEALTH

In time, this brand comes to encapsulate a promise about the goods it identifies—a promise about quality, performance, or other dimensions of value, which can influence consumers' choices among competing products. In dealing with direct and indirect partners in our profession each week, we strive together to ensure that the brand and the value attached to our renowned Gold Cross logo is accurate and promoted.

NEWS

We encourage you to support the companies featured in this edition’s booklet, as they proudly position a logo that is only found in pharmacy, and epitomises the pillars of our profession which are service, trust, and advice.

53 INDUSTRY NEWS & UPDATES

This edition includes our popular CPD features, in particular, Stratpharma has a new module on scars which we encourage you to complete. We also recommend our business and health editorials, 60 seconds with, and our company news features. Thank you to all the contributors, partners and supporters of ITK, wishing you an enjoyable read of this edition.

CONTINUING PROFESSIONAL DEVELOPMENT

Best Regards, Sean Tunny Editor - ITK Publications

BROUGHT TO YOU BY:

34 EMPOWER PATIENTS TO BETTER UNDERSTAND THEIR MEDICATION

28 HAEMOCHROMATOSIS AWARENESS WEEK 7 – 11 AUGUST 2017 38 ORAL CARE: THE ROLE OF SUGAR AND DIET 40 PROBIOTICS: A NOVEL THERAPY FOR ANXIETY & DEPRESSION? 44 HELPING PEOPLE LIVING WITH DEMENTIA TO NO LONGER FEEL ALONE

48 WOMEN’S HEALTH WEEK 2017: IT’S TIME TO PUT YOUR HEALTH FIRST

VACCINATION VICTORY FOR COMMUNITY PHARMACY AND PATIENTS

PRODUCT INSIGHT 6

MITIGATING RISK AND EXTENDING BEYOND-USE DATES (BUDS)

REGULARS 52 60 SECONDS WITH… 54 PRODUCT SPOTLIGHT 56 HEALTH CALENDAR 58 BUSINESS DIRECTORY

AN OVERVIEW OF DIABETES-RELATED ORAL COMPLICATIONS

21 THE ART OF SELLING IN PHARMACY

PLEASE USE THIS PUBLICATION TO KEEP YOUR PHARMACY IN THE KNOW EDITOR:

Sean Tunny 0457 029 052 sean.tunny@goldx.com.au

DESIGN:

BOOST Design 0431 609 683 boostdesign@optusnet.com.au boostgraphicdesign.com

PRINT & Fergies DISTRIBUTION: 07 3630 6500 |

fergies.com.au

5,892

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In The Know is independently audited under the AMAA's CAB Total Distribution Audit. Audit Period: 01/04/2016 - 30/09/2016 - Publisher Statement

PUBLISHED BY: Gold Cross Products & Services Pty Ltd: PO Box 505, Spring Hill Qld 4004 Contact: Ida Tornvall production@goldx.com.au In The Know is produced for the information of Australian Pharmacists. The presence of the logo of the Pharmacy Guild does not constitute endorsement of a product. The Pharmacy Guild of Australia accepts no responsibility for claims made by advertisers. Opinions and views expressed in articles do not necessarily reflect those of Gold Cross.

NEWS

Vaccination Victory for Community Pharmacy and Patients GEORGE TAMBASSIS National President of The Pharmacy Guild of Australia

VACCINATION IN COMMUNITY PHARMACIES BY TRAINED PHARMACISTS HAS WELL AND TRULY ARRIVED IN AUSTRALIA — AND ABOUT TIME TOO.

With changes in the regulatory environment, community pharmacies are now wellrecognised providers of vaccination services, particularly the influenza vaccine, to the community. In Australia, an average of 85 deaths and approximately 4,000 hospitalisations can be directly attributed to influenza. That’s why herd immunity is so important, and why it was just common sense to finally enlist community pharmacists into the immunity challenge. Just two years ago, pharmacist vaccination was in its infancy. Queensland had conducted a successful trial of adult flu vaccinations with very high patient satisfaction rates. Other States had just begun authorising community pharmacists to vaccinate. Now, two years on, and adult flu vaccinations in community pharmacy administered by trained community pharmacists have become the norm in all States and Territories. For an estimated half a million Australians and growing, the local pharmacy has become a convenient alternative to their GP or workplace for their annual flu jab.

workplace nurse vaccinators, increasing the number of adult Australians protecting themselves from contracting various strains of influenza.

should be electronically recorded, uploaded into the Australian Immunisation Register and, over time, included on patients' My Health Record.

And pharmacist vaccination doesn’t stop at influenza. A number of States and Territories have expanded the scope with Queensland adding measles and whooping cough. South Australia has recently announced it is going further by extending the vaccination authority for pharmacists to include measles, mumps, rubella, whooping cough, diphtheria, tetanus and polio. Other States and Territories are likely to follow suit.

With regards to training, Guild Learning and Development is partnering with Seqirus in an online course titled, Encouraging the uptake of influenza vaccination in your pharmacy, which will help pharmacists refresh their knowledge of key immunisation concepts.

A new development has seen some employers providing their staff with the ability to get their work-funded flu vaccination at a time of their choosing at their local pharmacy rather than having to attend a workplace vaccination clinic that might not suit their busy work schedules. Health insurers are also beginning to subsidise pharmacist vaccinations as a way of delivering increased value to their members and making them less susceptible to the health impacts of potentially dangerous strains of the flu.

Showing just how accepted pharmacistadministered flu vaccinations have become, the AMA — a long-standing critic — recently included an article by Professor Stephen Leeder in its medical journal, Australian Medicine, acknowledging the role of pharmacist vaccination in the health system.

With these expanding professional responsibilities, it is vital that pharmacists are fully trained to ensure that they are able to administer vaccinations safely and to a high-quality standard. The work of the Guild and the PSA in developing and delivering nationally accredited pharmacist training has been key in ensuring that the public and the wider health sector can have every confidence in pharmacist vaccinations.

We certainly welcome this acknowledgment that pharmacistadministered flu vaccinations in community pharmacies are complementary to GPs and

Equally, it is important that pharmacist vaccination is integrated into the broader health system. Vaccinations that are administered in community pharmacies

The course addresses the public health benefits of influenza vaccine and the role herd immunity plays in its efficacy, common myths and arguments against vaccination, and the common reasons for not vaccinating against influenza. It also describes how pharmacists can overcome some of these barriers. To enrol in this course, please visit myCPD.org.au.

"With these expanding professional responsibilities, it is vital that pharmacists are fully trained to ensure that they are able to administer vaccinations safely and to a highquality standard"

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 55 : AUGUST/SEPTEMBER 2017

Scars are more than just a cosmetic problem

Scars are a common and frustrating problem after an injury has occurred and can have both physical and psychological impacts to the sufferer.

Physical effects

Psychological effects1

• Raised and discoloured scars • Severe itchiness • Pain and tenderness

• Causes distress • Poor self esteem • Diminished quality of life

There are over 5.4 million surgeries performed annually in Australia, which has the potential to result in a physical scar for the patient2. Some of these include: • 200,000, burn injuries requiring treatment in Australia3 • Over 97,000 births resulting in a Cesarean section4,5 • Over 8,000 breast augmentation surgeries6

That’s over 14,000 Australians, looking for professional scar management every day. Scars cannot be removed completely, however with effective professional scar management the appearance and physical impacts of scars can be significantly improved.

The Australian College of Pharmacy offers accredited training to ALL pharmacists to broaden their knowledge and expertise on scarring and professional scar management therapies. Register for FREE at acp.edu.au

references: Accreditation Number: A1708SD1 This activity has been accredited for 1.5 hours of group 1CPD (or 1.5 CPD credits) suitable for inclusion in an individual pharmacist’s CPD plan which can be converted to 1.5 hrs of Group 2 CPD (or 3.0 CPD credts) upon successful completion of relevant assessment activities.

1. Bayat A et al. BMJ 2003;326:88-92 5. http://www.bellybelly.com.au/birth/why2. http://www.aihw.gov.au/WorkArea/DownloadAsset australias-c-section-rate-is-so-high/ aspx?id=60129559636 (Chapter 6, page 143) 6. http://www.accs.org.au/images/docs/ 3. http://www.fionawoodfoundation.com/ media/20151002-ACCS-Mythbusters4. http://www.abs.gov.au/AUSSTATS/abs@.nsf/mf/3301.0 Media-Release.pdf (page 5)

SD-AU-034-3-0617

Development of this CPD activity was supported by an unrestricted grant from Strataderm

PRODUCT INSIGHT

Mitigating Risk and Extending Beyond-Use Dates (BUDs) Do you have questions about PCCA Membership? Contact us today at PCCA Australia on (02) 9316 1500 or visit pccarx.com.au/join-pcca

MARINA HOLT BPharm MPS MACP PCCA Education and Training Manager

BUDS ARE ESSENTIAL AND MULTIFACETED There is a great amount of knowledge and risk involved in assigning beyond-use dates (BUD) to your compounded preparations. If a BUD is not properly assigned, it could negatively affect your patient. Stability is a major factor because a formulation could start to precipitate or experience chemical reactions over time. Overseas, the United States Pharmacopeia (USP) have been paying closer attention to the data used to substantiate the beyond-use dates (BUDs) of compounded preparations. So too, in Australia, regulators such as the Pharmacy Board of Australia have been concerned that pharmacists may not have the appropriate data to support long beyond-use-by dates.

CONFIDENCE WITH THE FORMULA DATABASE Imagine a database of formulas, available online, each with instructions and a BUD. Becoming a member of PCCA (Professional Compounding Chemists of Australia) grants you access to such a database. It provides BUDs for PCCA’s 8,000 proprietary formulas. Additionally, PCCA membership includes a program that studies the physicochemical stability of its members’ favorite formulas — over 100 and counting. Utilising a stabilityindicating method, the FormulaPlus™ program ensures accurate beyond-use dates backed by solid science.

MITIGATE RISK, EXTEND BUDS The FormulaPlus program has two purposes. First, it is designed to evaluate the chemical potency of a formula using a stabilityindicating assay, over a period of time, at refrigerated and room temperatures. Second, it is tasked with determining prolonged beyond-use dating for popular PCCA formulas.

METHOD VALIDATION

GET ACCESS

PCCA’s bracketed FormulaPlus studies have been subjected to an even greater level of testing. These studies have undergone full method validations in addition to the stabilityindicating BUD/potency testing. Method validation is a process to validate an analytical procedure. This is achieved by performing a wide range of characteristic analyses and evaluating the suitability of the analytical procedure for its intended application.

Do you want access to these resources? PCCA’s formula database, FormulaPlus Program and bracketed FormulaPlus studies are immediately available to PCCA members. Discover the wealth of support offered by PCCA. Call today on (02) 9316 1500.

FormulaPlus bracketed studies are analyses of formulas using a range of a low and high concentration of the active pharmaceutical ingredients (APIs). A compounded preparation containing the API(s) at a concentration that is equal to or between these bracketed strengths may be assigned the same BUD determined in the study (assuming all other ingredients remain the same). This means that each FormulaPlus bracketed study offers you BUDs for a range of API concentrations backed by solid science. Note that FormulaPlus testing is applicable only to stability testing — potency testing, method validation and degradation study. It does not include sterility testing. BUD testing has been carried out using only PCCA chemicals and procedures, and therefore cannot be claimed if all ingredients and processes do not match the formula and are within the range of concentration/strength of API studied.

COST SAVINGS The PCCA FormulaPlus BUD program can translate to significant savings for the compounding pharmacist. When comparing a 30-day versus a 90-day supply of medication, the compounding pharmacy saves on multiple set-up, labour and overhead costs.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 55 : AUGUST/SEPTEMBER 2017

ABOUT PCCA Three decades ago, a physician encountered a patient who required an anti-nausea medication that was no longer commercially available. The physician challenged a Houston-area pharmacist to compound the medication, so the pharmacist consulted with his peers and procured the chemicals necessary to prepare it. The prescription was a success, and the pharmacist realised that others in his field faced similar demands to help patients who require compounded medications. This network of pharmacists, united by a commitment to meet patient needs, was the foundation of PCCA (Professional Compounding Chemists of Australia), which was incorporated in 1981. Today, PCCA has become the independent compounding pharmacist’s complete resource for pharmaceutical grade chemicals, equipment, devices, flavours, CPD accredited training and education, pharmacy software, marketing, business and pharmacy consulting assistance. Our membership includes more than 3,900 independent community pharmacists in the United States, Canada, Australia and other countries around the world. PCCA is licensed by TGA and endorsed by The Pharmacy Guild of Australia.

CONTINUING PROFESSIONAL DEVELOPMENT 7 7

AN OVERVIEW OF

Diabetes-Related Oral Complications WINNIE NGUYEN B.Pharm, Cert IV TAE Training Coordinator The Pharmacy Guild of Australia Queensland Branch

Learning Objectives: After reading this article, the learner should be able to: 1. Describe the link between diabetes and poor oral health. 2. Describe the symptoms relating to poor oral health. 3. Discuss the appropriate course of management for a patient with diabetes who has an oral health complication. 4. Explain good oral hygiene techniques. 5. Describe the role of community pharmacist in promoting oral health.

National Competency Standards: 1.1, 1.3, 1.5, 2.1, 2.3, 6.1, 6.2, 6.3, 7.1, 7.2 Accreditation Number: G2017020 This activity has been accredited for 1 hour of Group 1 CPD (or 1.0 CPD credit) suitable for inclusion in an individual pharmacistâ&#x20AC;&#x2122;s CPD plan which can be converted to 1 hour of Group 2 CPD (or 2.0 CPD credits) upon successful completion of relevant assessment activities.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 55 : AUGUST/SEPTEMBER 2017

"Pharmacists are easily accessible and highly trusted and can play a key role in promoting oral health and identify diabetes-related oral health conditions."

ORAL HEALTH AND WELLBEING Although its value is often underestimated, practising good oral hygiene is a fundamental component of general wellbeing. Understanding this connection is key to living healthily. Many studies have suggested that people living with diabetes are at a greater risk of developing oral health complications, in particular people who have uncontrolled diabetes1,2. These groups of people are two to three times more likely to develop gum disease than those with well managed diabetes1. Statistics from Diabetes Australia suggest that around 1.7 million Australians have diabetes. This includes all types of diagnosed as well as silent, undiagnosed type 2 diabetes2. Given that pharmacists are easily accessible and highly trusted, they are positioned to play a key role in promoting oral health awareness and identify diabetesrelated oral health conditions. Diabetes is a common disorder with concomitant oral manifestation that impacts dental care. People with diabetes are at greater risk of having the following conditions3,4:

•• P eriodontitis (gum disease); •• Xerostomia (dry mouth); •• Oral candidiasis (fungal infection in the mouth/oral thrush);

•• Oral lichen planus (ongoing inflammatory condition that affects mucous membranes inside the mouth);

•• Burning mouth syndrome (chronic or recurrent burning in the mouth, which may include tongue, gums, lips and inside of cheeks).

WHY IS THERE A GREATER RISK FOR PEOPLE WITH DIABETES? There are several factors that contribute to an increased risk of developing oral complications. It is believed that people with diabetes are generally more susceptible to bacterial infections, and have decreased ability to fight bacteria that invade the gum due to their altered immune system and reparative processes3,4. Dry mouth can also occur when blood glucose levels are high3. Medications with anticholinergic, sympathomimetic, or diuretic activity may also cause dry mouth and taste disturbances3,5.

for tooth loss among individuals with diabetes4,5,6. Chronic periodontal disease is the progressive and irreversible destruction of the supporting tissues of the teeth which may lead to tooth loss because of extensive destruction to the alveolar bone (part of the jaw which forms and protects the sockets for the teeth)7,8. In individuals with poorly controlled type 2 diabetes, there is a hyperinflammatory response coupled with impaired wound healing and repair, which may enhance the inflammatory reaction and periodontal tissue destruction5. Subsequently, the inflammatory state induced by periodontitis can lead to insulin resistance and worsening glycaemic control. HEALTHY

PERIODONTAL DISEASE

Healthy Gums

Plaque

Healthy Bone Level

Pocket

Tartar Reduced Bone Level

The management of periodontitis requires debridement (scaling and root planing) to break up the bacterial biofilm (plaque). Systemic antibiotics are rarely required, and are not effective without local debridement as they cannot penetrate the biofilm9.

XEROSTOMIA Salivary function is essential for the maintenance of oral health. Saliva facilitates speech, cleanses food residues in the mouth, enhances taste and neutralises damaging food acids. It is organised into five major categories that serve to create ecologic balance: (1) lubrication and protection; (2) buffering action and clearance; (3) maintenance of tooth integrity; (4) antibacterial activity; and (5) taste and digestion10,11. In people with diabetes, the risk of having xerostomia, commonly known as dry mouth, occurs when there is lack of saliva production. Patients suffering from dry mouth will often complain of the following 9,10,11: •

Sticky, dry feeling in mouth and throat;

•

Difficulty chewing, swallowing, or speaking;

•

Altered, salty, bitter, and metallic taste in mouth;

Gum disease presents in three main phases9:

•

Lack of or diminished taste perception;

Gingivitis: Red swollen gums, gums that easily bleed while brushing and flossing, receding gum line and bad breath.

•

A prickly, burning sensation in the mouth;

•

Dry and cracked lips;

Periodontitis: Swollen and bright red gums, gums that are tender to touch, spaces develop between teeth, a build-up of pus between teeth and gums and loose teeth that don’t fit together when you bite.

•

Voice disturbances/speech difficulties;

•

Bad breath;

•

High rate of tooth decay;

•

Nocturnal discomfort.

Advanced periodontitis: Chronic bad breath, swollen and bleeding gums, deep periodontal pockets, and teeth are loose and misaligned. This final stage is most severe with actual loss in the bone and loss of periodontal tissues that support the teeth.

There are two major causes of dry mouth in people with diabetes; high blood sugar levels and medication side effects. The table below outlines the types of medications that can cause dry mouth.

MANAGEMENT OF PERIODONTAL DISEASE: Meticulous oral hygiene: tooth brushing and interdental cleaning. Chlorhexidine 0.2% mouthwash 10mL rinsed in the mouth for 1 minute. Patient education about oral hygiene and habit management, particularly smoking cessation. Removal of plaque and calculus with dental scaling by a dental professional. Root planing, which involves removal of plaque and calculus from deeper pockets.

PERIODONTAL DISEASE

In advanced periodontitis, periodontal surgery may be necessary.

It is well documented that periodontitis is considered to be one of the main reasons

REFERENCES: 1,2,3,6,9

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 55 : AUGUST/SEPTEMBER 2017

CONTINUING PROFESSIONAL DEVELOPMENT

DRUGS ASSOCIATED WITH DRY MOUTH: Drugs which directly damage the salivary glands - Cytotoxic drugs Drugs with anticholinergic activity Anticholinergics agents (e.g. atropine, hyoscine) Proton Pump Inhibitors such as omeprazole Psychoactive agents such as: - Antidepressants, including tricyclics (eg. Amitriptyline, nortriptyline, dothiepin), non-selective serotonin re-uptake inhibitors (e.g. fluoxetine); - Benzodiazepine; - Opioids; - Older generation antihistamines (e.g. promethazine, doxylamine, dexclorpheniramine) Bupropion. Drugs acting on sympathetic system - Ephedrine - Antihypertensive; alpha 1 antagonists (e.g. prazosin) and alpha 2 agonists (e.g clonidine), beta blockers (e.g. atenolol, propranolol) Drugs which deplete fluid - Diuretics REFERENCES: 10,11,12

The management of dry mouth is often focused on identifying the underlying condition causing the dry mouth, provide symptomatic relief, and educate on preventative measures.

MANAGEMENT OF DRY MOUTH:

•

Rinsing mouth after meals;

Ensure adequate hydration: - Drink adequate amounts of fluid (water and other non-sugary fluids)

•

Adhering to good oral hygiene;

•

Removing dentures every night and soaking them in a solution of water and denture-cleaning tablets;

•

Brushing gums, tongue and inside the mouth with a soft brush;

•

Rinsing mouth with water and spitting it out after using a corticosteroid inhaler;

•

Keeping glucose levels within target range.

Eat chewy foods to stimulate saliva flow and chew food thoroughly before swallowing: - Eat sugarless gum or suck sugarless sweets (avoid fruit flavours); - Chew celery; - Choose some foods at meal times that require chewing especially at breakfast. Limit caffeine and alcohol intake, and avoid cigarettes. Avoid astringent foods and drinks (e.g. black tea and coffee). Use bicarbonate mouthwashes: - A bicarbonate mouthwash can be made up by adding approximately half a tsp of bicarbonate powder to a glass of warm water. Rinse mouth on waking and at any time during the day. Limit sugar intake and avoid sugary snacks. Avoid acidic beverages (e.g. wine, fruit juices, soft drinks) and if must, limit consumption to meal times. Ensure good oral hygiene and regular dental examination. Table adapted from eTG Oral and Dental9

ORAL CANDIDIASIS The incidence of fungal infections in people with diabetes has been recognised for many years1,7,12. Infection is more prevalent in people with diabetes who smoke, wear dentures, have poor glycaemic control, and use steroids and broad spectrum antibiotics12. It is believed that high sugar levels lead to better conditions for the yeast to grow. A dry mouth coupled with a higher amount of glucose in the saliva can also make for favourable conditions12. Oral candidiasis (commonly known as oral thrush) presents as white, creamy-looking lesions on the inside of the cheeks and on the tongue. Thrush lesions can be painful and

may bleed when rubbed. The infection can spread through the mouth to the gums, the back of the throat, the tonsils and the roof of the mouth9. Treating oral thrush generally requires antifungal therapy such as miconazole 2% gel or Nystatin suspension, and correction of the underlying cause9. In the case of diabetes, bringing blood glucose levels into target range should be the primary focus. Effectively, lowering blood glucose should also lower the amount of glucose in the saliva and cut off the yeast’s food supply13. Prevention of oral thrush and its management depends on the following practices:

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ORAL LICHEN PLANUS Oral lichen planus is an ongoing inflammatory condition that affects mucous membranes inside the mouth. While the exact cause is unknown, people with diabetes have a higher prevalence of oral lichen planus14,15. The condition presents as a burning or stinging discomfort in the mouth when eating or drinking. Mild cases may be symptom-free. Spicy foods, citrus fruits and alcohol can be particularly troublesome. Oral lichen planus can also affect the gums causing it to be tender, and ulcers may appear 14. Patients with oral lichen planus will typically develop a white, lace-like pattern on the inner surfaces of the cheeks and tongue. However, it can appear as white and red patches or areas of ulceration on the lining of the mouth14. A dentist or doctor will be able to make a diagnosis based on the appearance of the mouth, and may take a biopsy for further microscopic examination. Mild cases of oral lichen planus may be asymptomatic and treatment is not required. For lichen planus that is causing discomfort, the following management plan can be used.

MANAGEMENT OF ORAL LICHEN PLANUS: Meticulous oral hygiene: brushing teeth and gums with soft tooth brush and regular visits to the dentist. Antiseptic mouth wash to keep plaque under control. Diluted chlorhexidine once to twice per week and avoid a mouthwash containing alcohol. If standard toothpaste irritates, try products that do not contain sodium lauryl sulfate. Lifestyle changes: advise about smoking cessation. Anaesthetic mouth washes if area becomes sore, particularly helpful if used before meals. Topical steroids in form of mouthwash, sprays, gel or paste can be applied locally to the mouth to reduce the pain/irritation. Keeping glucose levels within target range. Table adapted from DermNet New Zealand & British Association of dermatologist 14,15

BURNING MOUTH SYNDROME

ORAL HYGIENE

Burning mouth syndrome is a complex and debilitating oral condition that can affect people with diabetes16. It is characterised by pain in the mouth that is accompanied with a burning, scalding or tingling sensation. Other symptoms include dry mouth or altered taste in the mouth16.

Poor oral hygiene can lead to a cascade of health problems. It is vital that all patients who have diabetes are educated and reminded about good oral hygiene practices, as many oral complications can be prevented if there is good adherence to daily oral hygiene.

Three patterns of oral pain have been identified in people with burning mouth syndrome17: •

Type 1: Pain absent on waking and developing during the day;

•

Type 2: Pain present day and night;

•

Type 3: Intermittent pain, with painfree days.

The tongue is the most common site involved, followed by the lower lip and the hard palate. The pain caused by burning mouth syndrome can last for months or years and is often difficult to diagnose, therefore a detailed medical history and physical examination is crucial to differentiate from other oral conditions17,18. While there is no definitive cure for burning mouth syndrome, a small number of patients (3%) will resolve spontaneously, with over two thirds of patients experiencing some improvement over 6-7 years17,19. Given that burning mouth syndrome is a multifactorial disease, there is not one single drug or therapy can that result in complete remission of all oral symptoms. Treatment will include a combination of cognitive behaviour therapy, physical therapy such as acupuncture and laser, and drug therapy using antidepressants, benzodiazepines, topical local anaesthetics, and topical capsaicin17.People with burning mouth syndrome should avoid irritating substances such as20: • • • • •

Tobacco; Hot, spicy foods; Alcoholic beverages; Mouthwashes that contain alcohol; Products high in acid, such as citrus fruits and juices.

Nutrition is key to sustaining good oral health. The mouth is full of bacteria that thrive on starch and sugars found in food. In order to protect the enamel from tooth decay, encourage patients to choose foods low in sugar and starch. Where possible, brushing teeth or rinsing the mouth after a meal is beneficial. Toothbrushes with soft bristles are recommended in the removal of plaque and tartar build up. Studies have shown that hard or stiff bristles are not any better at removing plaque, and can cause damage to the gingival tissues and cause gum recession21. The optimal brushing duration necessary to achieve adequate plaque removal is two minutes21. Patients should be reminded that toothbrushes should be replaced every 3 to 4 months, or when the bristles are frayed. Regardless of technique used, brushing should touch upon the inner, outer and chewing surfaces and importantly, applied with gentle pressure to reduce risk of damaging the gums22. Toothpaste is an excellent vehicle for delivering fluoride to tooth surfaces to prevent dental caries, as well as promoting re-mineralisation and reduce sensitivity to the surface of the tooth. Most dental professionals will recommend using fluoride toothpaste. Studies have estimated an 18-40% reduction in tooth decay when drinking fluoridated tap water in conjunction with other sources of fluoride23,24. Brushing alone will only clean around 60% of the tooth surface, so it is important to emphasise that there are products available to help patients establish and develop good oral care routine25. Not flossing places

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patients at risk of developing gingivitis and cavities between the teeth as plaque builds up. Interdental cleaners such as floss and interdental brushes will effectively remove plaque between the teeth and get to areas where the toothbrush cannot reach. For patients to achieve optimal oral health, they must practice regular brushing and flossing, use of appropriate oral rinses, and plan visits to see the dentist.

THE ROLE OF COMMUNITY PHARMACISTS IN PROMOTING GOOD ORAL HYGIENE Community pharmacists are in a crucial position to increase awareness regarding the benefit of good oral hygiene to the community and recognise patients who may be susceptible to dental-related issues associated with poor or uncontrolled diabetes. Each counselling session should be used as an opportunity to remind patients about the importance of practicing good oral hygiene as a means of reducing or preventing further complications. Pharmacists should work collaboratively with dentists and other health care professionals to ensure patients receive timely advice on products, as well as treatment and referral for unresolved or undiagnosed oral complications.

PATIENT COUNSELLING TIPS: Ensure blood glucose levels stay within target Stress importance of establishing routine oral hygiene practices (cleaning teeth and gums twice daily with soft toothbrush, cleaning tongue, flossing, using fluoride toothpaste) Regular visits to the dentist for professional cleaning and oral examinations (every 6 months) Encourage smokers to quit If a patient with diabetes has hypoglycaemia, remind them to brush their teeth half an hour after consuming a high sugar content to prevent decay and cavities. Refer patients to dentist if their gums become swollen or inflamed or bleed excessively, or if they experience any other dental-related problems, such as tooth ache or changes in appearance of their teeth Be aware of medicines that have high sugar content in their formulation e.g. liquid preparations, chewable tablets and vitamins. If medicines must be taken, advise to brush teeth after use. REFERENCES: 1,2,3,7

BUSINESS 11 11 CONTINUING PROFESSIONAL DEVELOPMENT

REFERENCES: ‘Oral Health and Diabetes’, Talking Diabetes Diabetes NSW, no.26, 2012. At: http://diabetesnsw. com.au/wp-content/uploads/2014/12/DA-26-Oralhealth-and-diabetes.pdf

About Diabetes - Diabetes in Australia, Diabetes Australia, 2017. At: https://www.diabetesaustralia. com.au/diabetes-in-australia.

Oral health topics: Tooth Brushes. American Dental Association. 2016. At: http://www.ada.org/en/ member-center/oral-health-topics/toothbrushes

At: http://www.adawa.com.au/media/articles/ News/20120620-Tooth-Decay---Australia--039s-Most-Prevalent-Health-Condition-307/DentalHealth-Week-2012-Tooth-Decay.pdf

Koch G, Poulsen S, Espelid I, Haubek D. Paediatric Dentistry: A Clinical Approach (3rd edition) 2016 page 123.

Tooth Decay – Australia’s most prevalent health condition. Australian Dental Association. 2012.

Eveleigh G & N. Brushing alone ‘not enough’ for good oral hygiene. Netdoctor UK. 2012. At: http:// www.netdoctor.co.uk/healthy-living/news/a22096/ brushing-alone-not-enough-for-good-oral-hygiene/

Diabetes Australia – Victoria Member, 2015. At: https://www.diabetesaustralia.com.au/ news/11085?type=articles.

Working together to Manage Diabetes: A guide for pharmacy, podiatry, optometry and dentistry

Al-Shammari KF, Al-Khabbaz AK, Al-Ansari JM, Neiva R, Wang HL. Risk indicators for tooth loss due to periodontal disease. Journal of periodontology. 2005;76(11):1910–8.

Kaur G, Holtfreter B, Rathmann W, Schwahn C, Wallaschofski H, Schipf S, et al. Association between type 1 and type 2 diabetes with periodontal disease and tooth loss. Journal of clinical periodontology. 2009;36(9):765–74.

Leite RS, Marlow NM, Fernandes JK. Oral health and Type 2 Diabetes. Am J Med Sci. 2013; 345 (4) :271-273.

Auger S. The three phases of periodontal disease symptoms. Colgate Oral Care Centre. At: http://www. colgate.com/en/us/oc/oral-health/conditions/gumdisease/article/the-three-phases-of-periodontaldisease-symptoms-0814.

Oral and Dental Care (Published March 2012). In eTG complete. Melbourne: Therapeutic Guidelines; 2017.

Dry Mouth Syndrom. Better Health Channel. At: https://www.betterhealth.vic.gov.au/health/ conditionsandtreatments/dry-mouth-syndrome.

Ngo DYJ, Thomson WM. Dry Mouth – An overview. Singapore Dental Journal.2015; 36: 12-17.

Al-Maskarai A, Al-Maskari MY, Al-Sudairy S. Oral Manifestations and Complications of Diabetes Mellitus. SQU Medical Journal. 2011; 11 (2): 179186.

Oral thrush in adults. NHS UK. 2014. At: http:// www.nhs.uk/Conditions/Oral-thrush---adults/ Pages/Introduction.aspx

Oral Lichen Planus. British association of dermatologist.2016. At: http://www.bad.org.uk/ shared/get-file.ashx?id=111&itemtype=document

Gear K. Oral Lichen Planus. DermNET New Zealand. 2007. At: http://www.dermnetnz.org/topics/orallichen-planus/

Burning Mouth Syndrome. National Institute of Dental and Craniofacial Research. 2016. At: https:// www.nidcr.nih.gov/oralhealth/Topics/Burning/ Documents/BurningMouthSyndrome508c.pdf

Dyall-Smith D. Burning mouth syndrome. DermNet New Zealand. 2010. At: http://www.dermnetnz.org/ topics/burning-mouth-syndrome/

Gurvits G, Tan A. Burning Mouth Syndrome. World Journal of Gastroenterology.2013; 19 (5): 665-672

ASSESSMENT QUESTIONS myCPD users can submit answers online at mycpd.org.au, click on the ‘LOG INTO MYCPD’ button to access your account. Once you have logged in from the ‘myHome’ tab click on the blue ‘Journal Assessments’ button located at the bottom right hand side of the screen.

QUESTION 1 Choose the INCORRECT statement a. People with diabetes are more susceptible to bacterial infection as they have altered immune systems. b. Oral complications associated with diabetes include periodontitis, oral candidiasis, oral lichen planus, burning mouth syndrome and xerostomia. c. Chronic periodontal disease is a reversible condition that will resolve with good oral hygiene practice d. Patients with poorly controlled diabetes are at a higher risk of oral disease, particularly periodontitis.

QUESTION 2 Choose the INCORRECT option. Management of periodontal disease involves: a. Debridement (scaling and root planing) b. A course of antibiotics c. Chlorhexidine 0.2% mouthwash d. Good oral hygiene

QUESTION 3 Which of the following is NOT a common presentation of xerostomia? a. Saliva that feels sticky b. Difficulty chewing or swallowing c. Prickly or burning sensation in the mouth d. Inflammation of the oral mucosa membrane

QUESTION 4 Which of the following measures is inappropriate for the management of oral lichen planus? a. Using toothpaste that does not contain sodium lauryl sulfate b. Applying topical steroid to the local area of the mouth before eating c. Using antiseptic mouthwash that contain alcohol d. Avoiding spicy foods, citrus fruits, and alcohol

Grushja M, Epstein J, Gorsky M. Burning Mouth Syndrome. America Family Physician. 2002; 65 (40): 615-620.

Burning mouth syndrome. National Institute of Dental and Craniofacial Research.2016; 16. At: https://www.nidcr.nih.gov/oralhealth/Topics/ Burning/Documents/BurningMouthSyndrome 508c.pdf

Daly C. Prescribing good oral hygiene for adults. Australian Prescriber. 2009; 32: 72-75.

QUESTION 5 Which of the following statements about oral hygiene is INCORRECT? a. When brushing, a gentle pressure should be applied to avoid risk of damaging the gums b. Using fluoride containing toothpaste prevents tooth decay, promotes remineralisation and strengthens tooth enamel c. There is no evidence that soft bristle toothbrushes are any better than hard bristles in removing plaque d. Tooth brushing needs to be at least 2 minutes to achieve adequate plaque removal

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PRACTICE READY

Update for Pharmacists AARON D'SOUZA Pharmacist B.Pharm MACP

THIS UPDATE PROVIDES INTRODUCTORY AND PRACTICE INFORMATION FOR PHARMACISTS. FOR IN-DEPTH INFORMATION PLEASE CONSULT THE PRODUCT INFORMATION. Pharmacy is an exciting profession. We are placed at the front line of health in the unique position of optimising the quality use of medicines for our patients. A great part of that professional excitement is derived from the challenge of new therapies that frequently grace our dispensaries. For the everyday pharmacist on the front line, keeping up with new brands, new mechanisms of actions and new indications can be daunting. 'Practice Ready' aims to consolidate pharmacy information into a valuable, easy to ready article for the busy pharmacist. If there are therapy groups, medications or devices you'd like to see covered, please feel free to contact ITK.

SNAPSHOT

Zostavax® [Zoster Virus Vaccine Live-attenuated]

MF: Seqirus SCHEDULE 4: Prescription Only Medicine Not listed on the PBS. Placed on the National Immunisation Program on 1 November 2016 for people aged 70. Between 2016–2021, a catch-up program exists for people aged 70–79.

INDICATION

DRUG CLASS: Live attenuated vaccine

Zostavax is a one dose, high potency, live, attenuated Varicella-Zoster Virus vaccine.

THERAPY GOALS: Cell mediated immunity to Varicella-Zoster Virus

Zostavax is indicated for herpes zoster (shingles) prevention in people who are 50 years of age and over. It is also indicated for the prevention of postherpetic neuralgia and reduction of acute and chronic pain associated with shingles in people who are 60 years of age and over1.

STORAGE AND HANDLING: • Store between 2oC and 8oC • Do not freeze • Protect from light during storage

Zostavax® [Zoster Virus Vaccine Live] Whilst many experience an infection by the Varicella-Zoster virus without dire consequence as a child (“Varicella” / “Chickenpox”), recurrence of the dormant virus can lead to a significant reduction in quality of life the further we age. Herpes Zoster, referred to as ‘Zoster’ or ‘Shingles’ is exactly that — a reactivation of the Varicella-Zoster virus. Shingles will develop in one third of people2. A common morbidity of shingles is post-herpetic neuralgia. This is relevant to Pharmacists due to the ongoing nature of the pain suffered by patients which may last for months2. As such, pharmacists can provide critical symptomatic care, as well as helping raise awareness before shingles occurs to at-risk customers.

VARICELLA-ZOSTER Varicella-zoster virus (VZV) is a double-stranded DNA virus which is neurotropic and only found in humans3. Being highly contagious, the virus can be contracted by inhaling the airborne viral particles or by skin contact with skin lesions and/or exudate of the viral rash before crusting3,4.

DOSING: Subcutaneous injection – one dose

Blisters will form, then erupt over one week. They will heal over a two-week period. Some patients may experience ocular infections which is trigeminal nerve mediated. Patients may experience red eye, discharge, photophobia and visual loss. Corneal ulcers may occur5. Postherpetic Neuralgia is defined as pain which persists greater than three months after the onset of shingles. From the age of 50 to 80 years the incidence increases from 18% to 33%3.

PHASES OF SHINGLES 1,4,6

PRODROMAL

TIMELINE Day 0–5

• Vesicular rash • Postherpetic • Dermatomal Neuralgia pain • Motor • If ocular: neuron red eye palsies • Skin • Muscle pigmentation weakness • Scarring • Secondary bacterial infection • Blisters erupt over one week and heal over 2 weeks.

CONTAGION —

Skin contact with lesion exudate or aerolised particles

https://youtu.be/yd5n7P9xnJQ

PHASES AND PRESENTATION OF SHINGLES Patients will experience initial symptoms such as headache, temperature fluctuations and a general feeling of being unwell2. A painful vesicular rash may appear for between 10–15 days across the thoracic or lumbar dermatomes, or on the face. In the 48–72 hours before the rash appears, the skin may tingle, itch or become painful2.

CHRONIC Weeks to Months

SYMPTOMS • Itching • Tingling • Dermatomal pain (severe) • Headache • Photophobia • Malaise

After the primary VZV infection (varicella) is resolved, the virus will remain dormant in the dorsal root or trigeminal ganglia4. In later life, or during periods of immunosuppression, the virus can reactivate, resulting in shingles. This video graphically explains shingles:

ACUTE Day 5–20

If lesions have dried – no contagion

CLINICAL USE OF ZOSTAVAX1 Zostavax is a one dose, high potency, live, attenuated Varicella-Zoster Virus vaccine. Zostavax is indicated for herpes zoster (shingles) prevention in people who are 50 years of age and over. It is also indicated for the

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PRACTICE READY

VARICELLA-ZOSTER "The virus can be contracted by inhaling the airborne viral particles or by skin contact with skin lesions and/or exudate of the viral rash before crusting."

prevention of postherpetic neuralgia and reduction of acute and chronic pain associated with shingles in people who are 60 years of age and over 1. Zostavax is claimed to reduce the incidence of severe chronic shingles pain by 73% compared with placebo1.

MECHANISM OF ACTION As a live, attenuated vaccine, it is believed that the mechanism of Zostavax is via cell-mediated immunity7. For a basic understanding of cell-mediated immunity, please view the following:

ADVERSE EFFECTS Zostavax is generally well tolerated8. In the ZEST and SPS studies, the following reactions can be summarised: 1

GENERAL/ ADMINISTRATION

MUSCULOSKELETAL

VERY • Erythema COMMON • Pain/Tenderness • Swelling • Pruritus COMMON • Fatigue • Haematoma • Warmth

https://youtu.be/BXMFSUAx6XE

NERVOUS SYSTEM

• Headache • Extremity pain

POST • Nausea, Arthralgia, Myalgia, injection-site rash; MARKET injection-site urticaria. REPORTING

ZOSTAVAX CONTRAINDICATIONS1 • Ingredient hypersensitivity • Anaphylaxis to neomycin • Primary and acquired Immunodeficiency • Immunosuppressive therapies including high dose oral corticosteroids • Active untreated Tuberculosis

DRUG INTERACTIONS • •

Must be administered as the sole solution from the syringe. Do not administer with Pneumovax 23 (Reduced immunogenicity of Zostavax) (4-week separation of administration).

VACCINATION ACCESS

PRECAUTIONS1

As shown in the below table9,10,11,12,13,14,15 – currently there are no states where pharmacists can administer the Zostavax vaccine.

• Pregnancy • Current core body temperature above 38.5oC

STATE Permitted Pharmacist Vaccinations (Check specific state legislation conditions)

PREGNANCY AND LACTATION1 Pregnancy Category B2. It is recommended not to use Zostavax in pregnant women due to the known harm that naturally occurring VZV can cause. Pregnancy should be avoided for 3 months post vaccination.

QLD

Influenza, Diptheria-Tetanus-acellular pertussis, MeaslesMumps-Rubella, Adrenalin 0.1% or less (anaphylaxis only)

NSW

Influenza

Caution should be exercised if administering to breastfeeding mothers — risk is unknown.

ACT

Influenza

VIC

Influenza, Pertussis-containing vaccines

WHAT’S IN THE PACK?1

TAS

Influenza

Influenza, Measles-Mumps-Rubella, Diptheria-Tetanus-acellular pertussis, Diptheria-Tetanus-acellular pertussis-Poliomyelitis (Ages 16+)

Influenza

Influenza, Diptheria-Tetanus-acellular pertussis, Measles-Mumps-Rubella (Ages 16+)

• Single dose vial • Needleless syringe of diluent

STORAGE1 • Store between2 oC and 8oC. • Do not freeze. • Protect from light during storage.

DOSING INFORMATION1

Current June 2017

1. Inject prefilled diluent syringe into the vial of lyophilised vaccine. 2. Mix solution gently and thoroughly. 3. Withdraw solution into a syringe. 4. Inject complete solution subcutaneously, preferably into the upper deltoid region.

Patients seeking the vaccine should be referred to their GP. As of 1 November 2016, Zostavax has been placed on the National Immunisation Program by the Department of Health for people aged 70 years. Between 2016 and 2021, people aged between 71 and 79 can still access the free vaccine under the NIP.

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PRACTICE READY

PHARMACIST CONSIDERATIONS5 Pharmacists are encouraged to raise awareness to clients at risk of shingles. As stated above, this risk begins at 50 years of age and increases thereafter. Whilst only people who are 70 years of age — and until October 2021 those who are 70–79 — can access the free Zostavax vaccine under the NIP, many patients, especially those on immunosuppression therapies, may wish to pay for the vaccine out of pocket. During the prodromal stage and early acute eruptive stages, pharmacists may encounter patients seeking minor ailment advice who are unaware of their condition. Identifying symptoms of the phases, asking whether the person has had chickenpox in their lifetime, and appropriate referral to a GP may help reduce severity and the risk of chronic symptoms. Whilst not covered in this article, patients may be prescribed oral antiviral therapies such as Famciclovir 250mg q8h for 7 days, or Valaciclovir 1g q8h for 7 days, or Aciclovir 800mg 5 times daily for 7 days if the treatment is commenced within 72 hours of the rash onset5. Alongside this, if there is ocular involvement or patients who are immunocompromised, a referral to a GP is required5. Good practice should see pharmacists identifying appropriate products which may help with symptoms in each phase. This includes the use of hydrocolloid wound products6, calamine lotion, topical local anaesthetic preparations and capsaicin containing topical preparations16.

Pharmacists also have a key role in identifying pain relief options and referring or treating accordingly. Paracetamol, Ibuprofen or Aspirin (above 12 years of age) can be employed during the prodromal and acute phases alongside ice massage5,16. Postherpetic neuralgia is often hard to treat. Options include the aforementioned prodromal and acute pain treatments, as well as trials of a Tricyclic Antidepressant, Gabapentin or Pregabalin. The response to these options varies between 40 to 60%. A TENS machine may be a helpful adjunct during waking hours for a minimal 2-week period. Opioid analgesics may also be added to the pain therapy. This includes traditional opioids and tramadol5. Shingles represents an area of practice for pharmacists to show value to their clients via: 1. Awareness to the risks of shingles and consequences of reactivation 2. Awareness of the use of Zostavax to reduce the risk of reactivation 3. Identification of the early phases symptoms 4. GP referral 5. Prescription counselling 6. Symptom solutions 7. Chronic pain counselling and ongoing pain management.

REFERENCES: Merck Sharp & Dohme (Australia) Pty Limited. Product Information - Zostavax [Internet]. Merck Sharp & Dohme (Australia) Pty Limited; 2016 [cited 2017 Jun 15]. Available from: http://www.csl.com.au/docs/420/462/1604%20ZOSTAVAX%20PI.pdf 2 Australian Government Department of Health. Herpes-zoster (Shingles) [Internet]. [cited 2017 Jun 15]. Available from: http://www.immunise.health.gov.au/internet/immunise/ publishing.nsf/Content/immunise-herpes-zoster 3 Baird N, et al. Varicella Zoster Virus - Infectious Disease and Antimicrobial Agents [Internet]. 2003 [cited 2017 Jun 15]. Available from: http://www.antimicrobe.org/new/v21.asp 4 National Centre for Immunisation Research and Surveillance. Zoster vaccine for Australian adults - NCIRS fact sheet - zoster-vaccine-fact-sheet.pdf [Internet]. 2016 [cited 2017 Jun 15]. Available from: http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/zoster-vaccine-fact-sheet.pdf 5 Herpes zoster: antiviral therapy. In: Therapeutic Guidelines (electronic version) [Internet]. Published November 2014. © Therapeutic Guidelines Ltd (eTG March 2017 edition). Therapeutic Guidelines; 2014 [cited 2017 Jun 15]. Available from: https://tgldcdp.tg.org.au/viewTopic?topicfile=skin-soft-tissue-infections-viral&guidelineName=Antibiotic#t oc_d1e47 6 Suzuki K, Yoshikawa T, Tomitaka A, Matsunaga K, Asano Y. Detection of Aerosolized Varicella-Zoster Virus DNA in Patients with Localized Herpes Zoster. J Infect Dis. 2004 Mar 15;189(6):1009–12. 7 GM SM and K. Zoster vaccine (Zostavax): a review of its use in preventing herpes zoster and postherpetic neuralgia in older adults. Drugs Aging. 2010 Feb 1;1(27(2)):159–76. 8 Vesikari T, Hardt R, Rümke H, Icardi G, Montero J, Thomas S, et al. Immunogenicity and safety of a live attenuated shingles (herpes zoster) vaccine (Zostavax®) in individuals aged ≥ 70 years: A randomized study of a single dose vs. two different two-dose schedules. Hum Vaccines Immunother. 2013 Apr 1;9(4):858–64. 9 QLD Pharmacist Vaccination Guidelines [Internet]. [cited 2017 Jun 16]. Available from: https://www.health.qld.gov.au/__data/assets/pdf_file/0031/443983/dtp-pharmacistvaccination.pdf 10 NSW Health. NSW Health Pharmacist Influenza Vaccinations [Internet]. [cited 2017 Jun 16]. Available from: http://www.health.nsw.gov.au/pharmaceutical/pharmacists/Pages/ Pharmacist-Influenza-Vaccinations.aspx 11 ACT Pharmacist Vaccinations Factsheet [Internet]. [cited 2017 Jun 16]. Available from: http://health.act.gov.au/sites/default/files//Pharmacist%20vaccinations.pdf 12 SA Vaccine Administration Code March 2017 [Internet]. [cited 2017 Jun 16]. Available from: http://www.sahealth.sa.gov.au/wps/wcm/connect/ ea1c9b0040741be0959db7a05d853418/VAC+Version+1.4+March+2017+.pdf?MOD=AJPERES&CACHEID=ea1c9b0040741be0959db7a05d853418 13 Pharmacy Guild Tasmania Vaccinations Explained Guide [Internet]. [cited 2017 Jun 16]. Available from: https://www.guild.org.au/__data/assets/pdf_file/0022/5098/ pharmacist-vaccination-tasguild-bulletin-feb2016.pdf 14 Government NT. NT Pharmacist Immunisation [Internet]. 2016 [cited 2017 Jun 16]. Available from: https://health.nt.gov.au/professionals/environmental-health/pharmacistsand-schedule-8-medicines 15 Services D of H & H. Victorian Pharmacist-Administered Vaccination Program Guidelines [Internet]. [cited 2017 Jun 16]. Available from: https://www2.health.vic.gov.au:443/ public-health/immunisation/immunisers-in-victoria/pharmacist-immunisers/guidelines 16 myDr. Shingles self-care [Internet]. [cited 2017 Jun 16]. Available from: http://www.mydr.com.au/pharmacy-care/shingles-self-care 1

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When Glucojel first hit pharmacy shelves around Australia in 1941, it was the start of a wonderful friendship. Now, more than 75 years later, here are five reasons we think that relationship is still going strong.

Please contact your Nestle Sales Representative for assistance with Glucojel Jelly Beans

Aussies love Glucojel! It’s true! Thanks to Glucojel, Australians have been excited about visiting their local pharmacy for five generations. That’s why we’re still in the Top 10 when it comes to over-the-counter sales. Stocking Australia’s favourite jelly bean means giving your sales a sure-fire boost and delighting another generation of Aussies.

Nine all-natural colours

Since 2015, Glucojel has been made with 100% natural colours. No nasties here. Just nine great tasting flavours for guilt-free enjoyment.

75 years of fun! We’ve seen a lot change in our 75 years, from the first Apple computer to the first Apple Glucojel flavour. But one thing’s always stayed the same – great sales results for pharmacies.

Big is the new Black Consumers spoke and we listened. Our new 150g black packs have seen big success on the shelves, and even bigger support from fans of our most popular flavour.

We let consumers Express Themselves Our major consumer campaign – Express Yourself With Glucojel – concluded in June with thousands of amazing entries contributed from jelly bean fans around the world. Brand engagement has never been higher, and that means good business!

Pharmacy Technology & Innovation

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FRANK SIRIANNI

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Pharmacy Valuer MEDICI CAPITAL medici.com.au Twitter - @medicicapital

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Frank Sirianni can be contacted at Medici Capital, Level 10, 52 Collins Street, Melbourne VIC 3000 or by email at office@medici.com.au. Medici Capital, industry leaders in pharmacy valuation and management consulting. Helping pharmacists achieve their goals. medici.com.au

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BUSINESS

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 55 : AUGUST/SEPTEMBER 2017

BUSINESS

Much has been written about technology and innovation in pharmacy over the years. Community pharmacy relies heavily on technology to complete complex tasks and manage key patient data. Community pharmacy has also been an early adopter of technology relative to other community-based health practices.

systems, processes and pharmacy offers. Incremental changes are introduced to progress to a new, modified market offer or process. This is often referred to as continuous or dynamic innovation, and has generally been the focus of Australian pharmacy innovation.

However, have we been innovative?

2. Revolutionary

Pharmacy needs leadership to promote and provoke change, as well as embrace technology with a view to better patient management and new service delivery models. Technology and Innovation is more than just pharmacy management; it is increasingly about consumer/patient engagement and management!

I believe there are Forces of Change for Pharmacy. These are overriding forces which will no doubt impact on pharmacy and continue to drive the strategic value of community pharmacy. One of the forces is Innovation. It is my view that, fundamentally, we must move away from the current supply and remuneration debates to engage with the consumer or patient. We also need to rethink our business model and consider the broader scope of our relationship with the community (including other healthcare stakeholders).

INNOVATION The challenge here is that Technology Changes Everything — and then Changes it Again. Disruptive use of technology and new market approaches will see small, young and nimble operators with innovative ideas seize the market. We can no longer rely on 1950s-based service models (including the PBS) as the basis for the sustainability of community pharmacy. I read with interest in the Australian Doctor publication an article titled, Warning over ‘Uberisation’ of Medicine. The article refers to a new service which offers pay-by-the-minute GP consultations over the phone — Teleconsult. While the conversation around innovation has been significant, little has changed for many pharmacies over the last decade (or more). New models will inevitably need to be developed by pharmacy or by someone else. Innovation in pharmacy will require the generation of new ideas or approaches which are replicable, financially viable and satisfy community needs. For pharmacy, innovation must satisfy the needs and expectations of the consumers and pharmacy stakeholders (including pharmacy owners, employees and suppliers) in a better and more fulfilling manner. Innovation can take two broad forms: 1. Evolutionary

This is where the advances and changes are made based on current

Here, the focus is on disruption or new approaches. Revolutionary innovation is also referred to as discontinuous innovation. While there is some suggestion that this may be on the horizon for Australian pharmacy, this has not been the historical experience for pharmacy.

Inevitably, innovation is associated with risk. Creating a revolutionary system, process, or market offer for Australian community pharmacy will require risk-taking to create new opportunities for pharmacy and establish or sustain new markets.

How can we better engage with patients and consumers? 2. The power of the internet The internet, supported by the adoption of smart devices, is being widely adopted for business and social communications, as well as service delivery. Pharmacy needs to harness the power of the internet and ensure that it maintains a voice in the dissemination of information on medicines and health products. Pharmacy may also need to consider how it can utilise the power of the internet for better and more efficient delivery of products and services to its patients and consumers, in particular chronic patients. 3. Compliance and patient management Technology is readily available to assist community pharmacy to support patients with compliance and general patient management. While this goes beyond the current “supplyfocussed” approach, it is critical to patient– carer engagement and management. 4. Cost and business management

TECHNOLOGY While we often consider technology as relating to IT, computers and automation, the definition is that technology is “the collection of techniques, skills, methods and processes used in the production of goods or services or in the accomplishment of objectives, such as scientific investigation”. Since the 1970s, pharmacy has been an early adopter in information technology and computers. For pharmacy, IT in the initial dispensary computers enabled greater efficiency in the processing of patient prescriptions, storage of structure patient records and providing checks for the monitoring of safe medicine use. Subsequently, business software was introduced which enabled better business management, inventory management and supply chain management.

NEW FRONTIERS AND FOCUS IN INNOVATION AND TECHNOLOGY Let’s start (or perhaps continue) the discussion on new frontiers and areas of focus for pharmacy innovation and technology. The following list provides a few suggestions for us, and perhaps pharmacy generally, to consider, workshop and discuss. 1. New and innovative platforms We need to look to new and innovative models for service delivery for pharmacy services. Consumers and patients may not all require the current retail-focussed footprint and template. While there is some evidence of specialised pharmacy care, the pharmacy landscape is dominated by a universal overarching retaillocated model.

Pharmacy is constantly under review. Few sectors face the same constant pressure for change than that which is constantly being exerted on community pharmacy. Whether the change driver is global trends in pharmaceuticals, cost pressures on the PBS (or Government expenditure generally), or the disruptive impact of new supply channels or alternate providers, pharmacy will need to respond. Community pharmacy will need to use innovation and technology to reduce the effective cost of supply and better manage the supply chain. Such change will require better communication between the various stakeholders (including the Federal Government) and revolutionary improvement in the pharmacy supply chain and in business management.

TAKE-AWAY MESSAGE How are you innovating or using technology in your pharmacy? The key message is that pharmacy needs to innovate to create and maintain a sustainable business and community service. Perhaps you need to lead by example? We may all have many ideas … but the time is now for execution and implementation.

WHAT DO YOU THINK ABOUT THIS TOPIC? Email me your comments fsirianni@medici.com.au or call Medici Capital on (03) 9853 7933 for further information or to discuss the results.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 55 : AUGUST/SEPTEMBER 2017

It’s one thing to know what he’s buying today. But what about tomorrow? There’s a science to knowing the answer, and when you work with Nielsen, that science is working for you. Learn more about The Science Behind What’s Next™ at nielsen.com.

CONTINUING PROFESSIONAL DEVELOPMENT

The Art of Selling in Pharmacy AMANDA SEETO B.Pharm Professional Practice Pharmacist, The Pharmacy Guild of Australia, Queensland Branch Branch Committee Representative, The Pharmacy Guild of Australia, Queensland Branch

GLENN GUILFOYLE BASc MBA Principal The Next Level Pharmacy Services

Learning Outcomes: After reading this article, the learner should be able to: 1. Recognise the importance of customer engagement when delivering a health solution. 2. Effectively communicate with customers through listening, empathising and providing information. 3. Explain the importance of a pharmacist’s responsibility to assess symptoms and conditions and to make a professional judgement on the course of action. 4. Recommend interventions that may have a positive impact on the presented condition.

National Competency Standards: : 1.3, 2.1, 6.1, 6.3, 7.1 Accreditation Number: : G2017023 This activity has been accredited for 1 hour of Group 1 CPD (or 1.0 CPD credits) suitable for inclusion in an individual pharmacist’s CPD plan which can be converted to 1 hour of Group 2 CPD (or 2.0 CPD credits) upon successful completion of relevant assessment activities.

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BUSINESS PROFESSIONAL DEVELOPMENT CONTINUING

THE ART OF SELLING IS VIEWED BY MANY IN OUR PROFESSION AS A ‘DIRTY’ TOPIC, BUT IT IS AN ESSENTIAL COMPONENT OF WHAT KEEPS OUR BUSINESSES VIABLE. PHARMACISTS ARE (AND SO THEY SHOULD BE) EXCELLENT AT LISTENING TO THEIR CUSTOMERS AND PROVIDING ADVICE. HOWEVER, THE CONVERSION OF THAT ADVICE INTO THE SALE OF PRODUCTS THAT WILL REDUCE THE SYMPTOMS, TREAT THE CAUSE AND PREVENT A RECURRENCE IS A SKILL THAT FEW HAVE MASTERED. WHAT ABOUT PROFESSIONAL SERVICES: REVIEW OF MEDICATIONS, VACCINE ADMINISTRATION, BLOOD GLUCOSE MONITORING, WOUND MANAGEMENT? WHAT IS THE MOST EFFECTIVE WAY TO INCORPORATE THIS TOPIC INTO CONVERSATIONS WITH YOUR CUSTOMERS, WITHOUT SOUNDING OR FEELING LIKE YOU ARE A USED CAR SALESPERSON?

The proposed end result of this article is for the reader to have the ability to confidently have a discussion with a customer about their health. This includes initiating a conversation with a repeat script customer or during a symptom based over the counter (OTC) request, and being able to suggest evidencebased products and services to optimise their health and/or recovery. There are numerous ways to enhance customer engagement to increase product and solution sales. The first step to increase

“If your focus is on educating the customer and providing them with options beyond their expectation, then you do not have to ‘sell’; the customer will decide what will be sold.”

engagement is to leverage the customer’s expectation that you will react and respond to their perceived needs and reasons for coming in. Aim to progressively recalibrate such expectations through a strategic approach of leading the conversation with prompting questions and proactive suggestions. Insightful questions, and unanticipated advice and medication or service options will wrest control of the agenda and lead them into associated aspects of their medicines, condition and health that: •

Extends what they know;

•

Challenges what they think they know, and;

•

Teaches what they don’t know.

Through astute questioning that invites the customer into the conversation, you convert what could be perceived as a lecture on their health condition, to an interactive discussion on actions that will hopefully improve your customer’s overall health outcome. For example, a basic request for an antihistamine may transform to educating the customer on allergy prevention with an intranasal corticosteroid spray.

WHAT THE DATA SAYS Data collected by observational audit at the dispensaries of more than 250 pharmacy studies over recent years, indicates that the industry norm is to deliver on the perceived, and often shallow, needs of the customer. The data indicates that it’s far less common that the customer receives additional, unanticipated medicines or health advice and associated additional products or services to choose from, in order to create more of a complete solution. Consider this: •

Of the average 1:37 engagement with an OTC customer, only 0:16 (15%) is staff driven conversation that prompts and proactively provides unanticipated advice and medicines/ health options for the customer to choose from for a more complete solution1.

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•

For the script customer, the input is even more marginal: of the average 2:21 engagement, only 0:11 (8%) is of this proactive nature1.

An observational audit conducted in the UK similarly revealed that an average of 10.9% of pharmacist time is spent on counselling of prescribed and non-prescribed medicines2. This conversation mindset is referred to by some consultants as ‘react and respond’. With regards to non-script health product add-ons for both the prescription and OTC customer, this lack of engagement results in: •

For every 100 OTC customer visits, the industry standard basket size for nonscript health products is 118 i.e. little more than a 1 product : 1 customer ratio1;

•

For every 100 script customer visits, the industry standard is to add on 29 non-script companion products i.e. almost 3 in every 4 script customers walk out with nothing more than what the doctor prescribed1.

This prompts the question: do we have to undertake a fast food chain style ‘do you want fries with that’ ethos to survive the economic pressure afflicting all pharmacies? The answer is both yes and no. Yes, in the sense that the end result should be a happy customer leaving with a larger than expected bundle of products and/ or services, due to skillful questions and suggestions from the engaging staff member. No, in the sense that when the unqualified fast food retail assistant offers you fries as an add-on to your burger, he/she is: •

Not teaching you anything you don’t know (because everyone knows what fries are), and;

•

Not offering anything that is likely to improve your health.

In pharmacy we have a moral obligation to execute the opposite of the two abovementioned points. A customer who has been educated on the benefits of taking a

CONTINUING PROFESSIONAL DEVELOPMENT BUSINESS

The Art of Selling is an essential component of what keeps our pharmacies viable.

coenzyme Q10 supplement whilst on a statin, the convenience of a dose administration aid, and offered an opportunity for a MedsCheck, is more likely to be a loyal customer than the one who simply signs for their repeat prescriptions and leaves without further discussion.

none of their importance, they need to be supplemented to ascertain the relevance of the possible complete solution for each unique customer. There are a number of acronyms in our industry that can do this, one being TRAPS1: •

Treat the condition;

WHAT WE NEED TO DO

•

Relieve symptoms;

In their training, pharmacists have been hardwired to keep risk management and duty of care in the forefront of their minds. Acronyms and frameworks like WHAT-STOPGO and CARER help to reinforce that risk management hardwiring. However, it’s no longer enough just to be good at WHATSTOP-GO if you are to have a proactive health conversation with your customer. The good news is that the necessary re-wiring of the brain and tongue only requires mastering a small number of skills. However, executing this with confidence and competence in the real world of retail pharmacy will require the tenacity and practice akin to learning a new foreign language.

•

Alleviate side effects;

•

Prevent the condition/recurrence;

•

Support overall well-being in relation to the condition.

The necessary skills encompass: •

Asking the right questions;

•

Asking them the right way;

•

Communicating the selected solution the right way;

•

Handling objections.

Whilst frameworks like WHAT-STOP-GO lose

If your focus is on educating the customer and providing them with options beyond their expectation, then you do not have to ‘sell’; the customer will decide what will be sold. As part of your role of providing a professional service, you are leveraging the ‘react and respond’ part of the conversation that meets the customer’s anticipated needs; and proactively exceeding their expectations through education. The profoundly powerful skill at the heart of the consultation with the customer, is to be able to ask the right questions the right way. The secret is to elevate the conversation from the superficiality of signs, symptoms and side effects, to implications on work, rest and play. How is this done? As soon as the customer reveals any of their specific signs, symptoms and side effects, simply ask something like: • How does that affect you day to day?, or;

•

How does that impact you at night?

Now that the conversation has been elevated into the domain of lifestyle impacts, you will be able to connect with your customer at a much more empathic level. The customer is very likely to feel like they are REALLY being listened to and REALLY understood. This technique can easily be utilised in any conversation, from the initial symptom based request to the presentation of a repeat prescription for an ongoing medication. Other skills to be learnt here include the art of paraphrasing, and verbalising your nominated product/service/advice in terms of specific lifestyle impact benefits that circle right back to the customer’s description of their work/rest/play impediments. For example, asking a patient in the first few months of antidepressant medication if they are finding a benefit from it, will hopefully reveal a positive response. Following that with the above suggestion of asking ‘how does the medication impact you at night?’ may result in a comment about sleep not being so great lately. Paraphrasing the benefits of the antidepressant on your customer’s mood, with a suggestion on changing the timing of the dose, and the offer of a MedsCheck to review the other medications (that may result in the implementation of a dose administration aid) demonstrates that your recommendations are in response to their issues.

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CONTINUING BUSINESS PROFESSIONAL DEVELOPMENT

BREAKING DOWN THE CONVERSATION A complete solution conversation should feature two connected parts: 1. The diagnosis; 2. The consultation. Whether the customer is script bearing or not, whether condition is new or ongoing, a diagnosis should never be assumed, nor glossed over in haste to reach the point of discussing symptomatic relief. The diagnosis part of the conversation can be broken down to four clear objectives: 1. Diagnose the condition; 2. Determine if the condition can be treated; 3. Determine if any prescribed/ requested medication is for treatment of the condition (at this point it is important to differentiate the purpose of the medication from use for symptomatic relief or side effect alleviation from another medication); 4. Determine if intervention is warranted regarding any prescribed/requested medication. With those clear circumstances understood, then you can effectively begin to consult towards a complete solution. At this point it is useful to cycle through the five health domains within TRAPS that make up the potential complete solution with your customer.

PHARMACISTS NEED TO GET OUT THERE A current ‘reality check’ shows that the service level provided by our industry is somewhat stale and stagnant: •

Anywhere between 50 – 90% of ongoing medicine takers are not taking the medicine as prescribed1;

•

61% of prescriptions are handed out by a pharmacist; of this 61%, only 45% of the time the medication is handed back with pharmacist conducting the basic counselling of ascertaining who the medication is for, what condition is being treated and how to take the medication1.

A meta-analysis of studies of our counterparts overseas revealed that the bulk of pharmacists’ time is spent on the assembling and labelling of prescriptions: from 25.5% in the UK, to over half of the time in the US2. Too often, pharmacists assume that the stable, ongoing medication consumer has already been told how to take their medication safely and effectively several times over, and anecdotally, feel that they may annoy the customer to do so again. A US study revealed that the likelihood of a patient receiving counselling was not related to staffing, automation or workload, but the public perception and practice habits of the pharmacist3. Perhaps paradoxically, this situation of reminding pharmacists of the standard counselling practices should be leveraged to encourage a more proactive conversation about overall wellbeing and health.

TAKE A RECORD OF THE CONVERSATION In many sales sectors (such as company representatives who visit our pharmacies daily), the solution seller will note key discussion/action/advisory points for each visit. This appears to be a relatively uncommon discipline in pharmacy which, in turn, denies the pharmacist the ability to optimally conduct the consultative and complete solution conversations for each customer from one visit to the next. Each visit is more like a conversation episode, rather than a progressive milestone in ongoing care management. Consider your classic, stable statin customer: if such patient notes were immediately accessible via the terminal at the script counter, a quick glance would arm the pharmacist with key bullet points from prior customer visits. Begin with an open question such as ‘how have you been going lately with that?’ (‘That’ being the medication, condition or product suggestion previously discussed). Depending on the nature of the response, you can leverage something in it or something relevant in recent discussions to continue working towards a solution. Alternatively, you could simply ask a closed question such as ‘when are you next due to get your cholesterol levels tested?’

Following the disciplines outlined already, set yourself up to leverage information from your customer to gain the necessary outcomes of the ‘diagnosis’ conversation, which leads into the solution consultation. Remembering the second of Stephen Covey’s ‘7 habits of highly effective people’ 4, begin with the end in mind; have a clear picture of what options you are going to explore with your customer when using TRAPS to conduct the conversation. As the customer leaves with the tailored complete solution, invest a minute or so to key the critical discussion points into your dispensing software, so that they can be leveraged in this way again, on that customer’s next visit. For example, ‘last time you came, we discussed and agreed X, Y and Z; how did you go with that?’

INCLUDING PROFESSIONAL SERVICES The current fervor around selling professional services, means there is a possible risk that you may appear disjointed and sound like you are throwing mud and hoping some will stick. If we take vaccinations and MedsChecks as two leading examples, and think of them in terms of the strategic consultation framework that is TRAPS, it is likely that vaccinations will fit into the ‘prevention’ topic of the integrated and strategic consultation; MedsChecks will likely fit into ‘support’. By incorporating these services into the logics and methodology of the professional consultation, as outlined above, any recommendation provided will be contextualised, and sound like an element of an organised, integrated and tailored solution, rather than a disjointed idea. Observational audit data clearly demonstrates that the pharmacy industry has the potential to substantially increase proactive customer engagement. Pharmacists have the opportunity to expand on their current skill set by incorporating the right questions, asked in the right way, into their counselling sessions to deliver a complete health solution to every patient. Add to this more dedicated time for the pharmacist on the counter, and the habit of recording important points from these conversations into your database, and you will be well on your way to healthy loyal customers choosing to shop at your pharmacy.

“Whether the customer is script bearing or not, whether condition is new or ongoing, a diagnosis should never be assumed, nor glossed over in haste to reach the point of discussing symptomatic relief.” GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 55 : AUGUST/SEPTEMBER 2017

25 CONTINUING PROFESSIONAL DEVELOPMENT BUSINESS 25

“As the customer leaves with the tailored complete solution, invest a minute or so to key the critical discussion points into your dispensing software, so that they can be leveraged in this way again, on that customer’s next visit.”

QUESTION 1 Which of the following statements about customer engagement is true? a. The data indicates that it is very common for the customer to receive unanticipated health advice. b. The average OTC customer receives over one minute of staff driven conversation per visit. c. The average prescription customer receives 11 seconds of staff driven conversation per visit. d. The pharmacy industry norm is to provide over and above the perceived needs of the health customer.

QUESTION 2 Which of the following is not a necessary skill required to have a proactive conversation with a customer? a. Asking the right questions in the right way. b. Communicating the solution only in a written format. c. Prevent the condition or a recurrence. d. Treat the condition.

QUESTION 3 Which of the following statements is true, in regards to pharmacists being involved in the health conversation? a. Over 90% of prescriptions are handed out by a pharmacist. b. Pharmacists believe that instructing how to take a medication several times over is not annoying to a customer. c. The standard counselling practice should be leveraged to encourage a more proactive conversation about health. d. Over 60% of on-going medicine takers take their medicine as recommended.

QUESTION 4 When having a conversation with a customer, which is the most correct answer? a. Try to remember every conversation so that you can continue it next time. b. Always ask a closed question to get the answer you want. c. Treat each conversation as its own event, rather than progressing towards a milestone in on-going care management. d. Have a clear picture of what options you are going to explore when using the TRAPS framework.

REFERENCES The Next Level. What we measure and why. At: http://salessystem.com. au/pharmacy-benchmarking/what-we-measure/ [accessed 31 May 2017] Data from research is available upon request via ‘Contact Us’ link in website. 2 Davies JE. (2013). Community Pharmacy Businesses and Community Pharmacists (Doctoral thesis, University College London, London, England). Retrieved from http://discovery.ucl.ac.uk/1384825. 3 Angelo LB, Christensen DB, Ferreri SP. (2005). Impact of Community Pharmacy Automation on Workflow, Workload and Patient Interaction. Journal of the American Pharmaceutical Association 45: 138-144. 4 Covey SR. The 7 habits of highly effective people. At: https://www. stephencovey.com/7habits/7habits-habit2.php [accessed 22 May 2017]. 1

QUESTION 5 Which of the following is not an objective in the diagnosis part of the conversation? a. Diagnose the condition. b. Determine if the condition can be treated. c. Refer each patient to the GP for confirmation of diagnosis. d. Determine if any requested medication is for treatment of the condition.

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BUSINESS

Is Now the Time to Automate My Pharmacy? ROBERT ALLEN CEO Dose Innovations

WITH MORE THAN 5000 PHARMACIES IN AUSTRALIA OFFERING A RANGE OF PRODUCTS AND SERVICES, THERE ARE CERTAINLY INDICATIONS THAT MANY PHARMACIES SHOULD AUTOMATE THEIR DISPENSARIES. YOU HAVE EITHER AUTOMATED OR YOU HAVE NOT. IT’S POSSIBLE THAT YOU’RE CURRENTLY WEIGHING UP THE PROS AND CONS OF AUTOMATION, AND IF NOW IS THE RIGHT TIME TO INVEST. IS AUTOMATION ALL IT’S CRACKED UP TO BE, OR IS IT ALL HYPE? WHAT IS THE ROI? WHY ARE OTHER PHARMACIES AUTOMATING?

There are several things that may influence your timing in automating your store: Market factors •

•

Profitability is lower than ever. This will improve with 01 July changes and a growing market (i.e. older Australians). Our remuneration has been evolving over the last few years. Generic medicine margins are no longer around to fund inefficient processes and potential investments in technologies. Our remuneration for professional services has increased, but workflow change is needed to be able to access this additional income. Competition has increased. If you are simply processing prescriptions without expanded pharmacist–patient contact, then you are competing with the discounters. The goal is to give your patients a reason to come to your store that is not available elsewhere. Automation solutions that are available today are far superior than were available to you ten or even seven years ago. More functions and options are available than ever before. The price of the automation solutions has bottomed out, with increased competition and the exchange rate set to worsen very shortly. Interest rates are an all-time low. These rates are set to rise in the very near future. Competition in the market is at its highest, which means the customer is in the box seat. You have over a hundred other pharmacies to ask how automation has improved their store.

According to market factors, there has never been, and never will be a better time to automate your pharmacy. With the above in mind, automation suppliers should be taking more orders than they can cope with. But, that’s not the case at the moment, so why is that? The above question could be modified to possibly relate more closely to why more pharmacies are not automating. Do you believe that you need to automate your pharmacy to be competitive in the next ten years? If the answer to the above question is a yes, then chances are you have already invested or are investigating your available options. If your answer is yes, but you haven’t started the process, there could be a range of reasons why you’re not investigating automation: • • • • • • • • •

I am selling my pharmacy. I am waiting for the price of automation to come down. I am waiting for interest rates to be lower. I am investigating all other options before I investigate automation. I don’t like machines/don’t believe in automation. I can’t afford it (at least I don’t believe I can). I have had a bad experience with pharmacy automation. I am waiting six months. etc., etc.

If your answer is no, then there’s no need to look at automation for the foreseeable future. So, given that the market factors are showing that now is the best time to automate, and the average time taken to make a purchasing decision is 6–12 months, with

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time for installation upon purchase on average from 3–6 months, potentially you aren’t looking to automate your pharmacy until 2019. If you are wanting to automate earlier than this date, you probably should commence your investigations very soon. Each of our customers (Rowa) have been asked why they are considering automation. Some of the reasons are: • Increased patient–pharmacist time – 80% • More time to deliver professional services – 75% • Improve workflow in my store – 65% • Dispensary efficiency (reduced labour cost in dispensary) – 60% • Accurate inventory and automated stock receipt – 60% The new 6 CPA changes that commence 01 July relate to $600 million over the next three years. Pharmacies that embrace change will maximise their share of this funding. 2019 will be halfway into this agreement and, so hopefully, $300 million would have already been paid to pharmacies delivering MedChecks, providing DAAs and staged supply to their maximum ability. Some questions your pharmacy will need to answer: •

• •

What strategies do we have to maximise the changes to professional service funding? Are we able to sustain these strategies for the next three years? Would it be easier to implement and sustain these changes if our pharmacy was automated?

If you are asking yourself whether you can afford to automate your pharmacy, the question you should be asking is, can I afford not to?

HEALTH

Haemochromatosis Awareness Week 7–11 August 2017 DR DIANNE PRINCE BA, MEd, DBA President Haemochromatosis Australia

WHAT IS HAEMOCHROMATOSIS AND WHO IS AFFECTED? Haemochromatosis, or inherited iron overload disorder, is the most common genetic disorder in Australia, but not many know that haemochromatosis is so prevalent. 1 in 200 Australians of northern European background have a genetic predisposition for this condition. This equates to about 90,000 individuals. What is the risk of developing haemochromatosis in my lifetime?

GENOTYPE*

RISK OF IRON OVERLOAD

HOW MANY CAUCASIAN AUSTRALIANS HAVE THIS GENOTYPE?

Normal genotype

no increased risk

2 in 3

Heterozygous H63D

probably no increased risk

1 in 5

Heterozygous C282Y

probably no increased risk

1 in 9

Homozygous H63D

very slightly increased risk

1 in 100

Compound Heterozygous C282Y / H63D

increased risk

1 in 50

Homozygous C282Y

greatly increased risk

1 in 200

(Source – Professor Martin Delatycki, Haemochromatosis: Your Questions Answered p. 5)

Not everyone with genetic predisposition will develop iron overload, and current research is working on identifying other factors which influence this. In Australia about 1 in 3 males and 1 in 30 females who are aged between 40 and 70 years, and are homozygous C282Y will, at some stage, develop clinical features of iron overload disease.

Factors which reduce the degree of iron load include: •

the number of times a person has donated blood

•

bleeding for any reason, such as accidents and operations

•

for menstruating women, the amount of blood lost in their periods

•

number of children (pregnancy uses up stored iron).

(Source – Professor John Olynyk, Haemochromatosis: Your Questions Answered p. 11)

WHAT DO PEOPLE KNOW AND HOW CAN PHARMACISTS HELP? Most people know too little iron, or iron deficiency, can be bad for your health. However, far fewer realise that too much iron can also be dangerous. With haemochromatosis, the body absorbs excess iron which builds up in the organs and joints over many years and eventually becomes toxic. Early symptoms include joint pains, fatigue, weakness and sexual dysfunction. If untreated, haemochromatosis can lead to more serious conditions including diabetes, liver cancer and cirrhosis, heart failure and osteoarthritis. The good news is that it is easily treated if detected early, and is no barrier to a normal, healthy life. Haemochromatosis Australia is asking for your support to raise awareness of haemochromatosis and improve the rate of early diagnosis. The longer haemochromatosis is left undetected and untreated, the greater the risk of ill-health caused by iron overload. There are several ways you can help raise awareness of the condition. When someone comes to you seeking advice on feeling tired or achy for an extended period, suggest they talk to their GP and get blood tests. The early symptoms of iron overload and iron deficiency can be very similar, and iron deficiency should be proven before commencing iron or a supplement that might contain iron. People with elevated Serum Iron, Serum Ferritin and Transferrin Saturation on repeat tests should be referred for gene tests.

(Source – Professor John Olynyk, Haemochromatosis: Your Questions Answered p. 14)

Factors already known to influence the degree of iron load include: •

a person’s age (increased age provides a longer time to develop iron overload)

•

the amount of iron in a person’s diet

•

the amount of iron a person takes in vitamin pills and medications

•

the amount of alcohol a person drinks.

"With haemochromatosis, the body absorbs excess iron which builds up in the organs and joints over many years and eventually becomes toxic."

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HEALTH

"If untreated, haemochromatosis can lead to more serious conditions including diabetes, liver cancer and cirrhosis, heart failure and osteoarthritis."

BLOOD TESTS If you have ever had a blood test which shows that you have increased iron levels or that you have abnormal liver function, you should be tested for haemochromatosis. IRON LEVELS TEST NAME

ABNORMAL RANGE FOR FEMALES

ABNORMAL RANGE FOR MALES

Serum Iron

Above 30 µmol/L

Serum Ferritin (SF)

Above 200 µg/L

Above 300 µg/L

Transferrin Saturation (TS%)

Above 45%

Above 50%

µmol/L = micromoles per litre and µg/L = micrograms per litre

There are a number of reasons apart from haemochromatosis that can lead to increased iron levels and abnormal liver function. These include hepatitis B infection, hepatitis C infection, alcoholic liver disease and fatty liver (also called Non-Alcholic Fatty Liver Disease or NAFLD). (Source – Professor Laurie Powell, Haemochromatosis: Your Questions Answered p. 5)

Once diagnosed, iron levels should be monitored on a regular basis to ensure safe levels are maintained. Haemochromatosis cannot be treated through diet, but a healthy nutritious diet is very important. However, since Vitamin C assists in iron absorption, people with haemochromatosis should avoid high doses of it, particularly with meals high in iron. People with high iron levels should also be very careful eating raw seafood due to the risks associated with the vibrio vulnificus bacterium, which is found in raw seafood and thrives in the blood of people with high Serum Ferritin. Whilst it is rare in Australian waters, it is not unknown, and it can cause life-threatening septicaemia. For more information and support resources, go to Haemochromatosis Australia’s website ha.org.au or call our InfoLine 1300 019 028. You can also view a set of excellent short videos explaining haemochromatosis in simple terms on our YouTube channel youtube.com/HaemochromatosisAust. You may even like to play our fun and very informative twominute animated video in your pharmacy during Haemochromatosis Awareness Week, and print one of our A4 posters from haemochromatosis.org.au/haw to display in your pharmacy.

WHO ARE WE?

MANAGING HAEMOCHROMATOSIS Haemochromatosis is treated by unloading excess iron through removal of blood. GPs can register their patients online for venesections with the Australian Red Cross Blood Service via their Hi Ferritin app on line. Some pathology centres also do venesections. HA has created a directory of venesection centres around Australia and people can call our InfoLine on 1300 019028 to find their nearest centre.

Haemochromatosis Australia is the support, health promotion and advocacy group for people with haemochromatosis and their families. Our medical advisors include some of the leading academics and clinicians in the field of haemochromatosis. Haemochromatosis Australia is a not-for-profit registered charity, endorsed by the ATO as a deductible gift recipient. It is run entirely by volunteers. REFERENCES 1 Haemochromatosis: Your Questions Answered - ha.org.au

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GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 55 : AUGUST/SEPTEMBER 2017

BUSINESS

PHARMACY ALLIANCE PARTNER PROGRAM

We Do the Hard Work for You NIMFA MARTINEZ General Manager, Marketing and Member Services Pharmacy Alliance

PHARMACY ALLIANCE IS A MEMBER-BASED NETWORK WITH OVER 650 MEMBER PHARMACIES. WE PROVIDE INDEPENDENT PHARMACIES WITH THE RETAIL TOOLS AND EXPERTISE TO IMPROVE PROFITABILITY AND STREAMLINE IN-STORE OPERATIONS. OUR MEMBERSHIP TIERS ARE DESIGNED TO COVER THE DIFFERENT BUSINESS TYPES AND VARYING LIFESTYLE GOALS OF ALL INDEPENDENT PHARMACY OWNERS, AUSTRALIA WIDE.

Our premium membership model is the Pharmacy Alliance, Partner Alliance membership. This program has been established for over ten years, gaining credibility within the industry as a known and trusted program. Primarily available for existing Pharmacy Alliance members, we can provide you with the opportunity to invest in a pharmacy with other partner owners, allowing you access to a passive income. Our Partner Alliance pharmacies are managed on behalf of our members by a highly experienced and dedicated Pharmacy Group Manager. Our Pharmacy Group Managers are experts when it comes to HR management and retailing, and business development, drawing on the resources at the Member Support Office (MSO). The MSO is the centralised hub of Pharmacy Alliance and each person in the MSO is a specialist in their selected area, including Marketing, IT, Merchandise and Procurement, and they are constantly working on ways to discover growth opportunities by keeping you up to date on industry trends. With your PGM and the support from the MSO, owners can be confident that their business is in good hands and will run smoothly and profitably. The Pharmacy Group Managers are accountable for fulfilling an agreed budget and P&L, and will provide owners with full transparency through monthly reporting and cash flow forecasts.

The Pharmacy Group Manager is responsible for full management of the Partner Alliance pharmacy including: •

Reporting and budgeting

•

Store team management, including recruitment, training and performance management

•

Standard operating procedures

•

Compliance and business performance reviews

•

Providing monthly and annual reports to keep up to date on financial performance

•

Pharmacy Board Compliance

•

Driving the business in the local community.

A Pharmacy Group Manager will call into the pharmacy on a monthly visitation cycle with checklists based around seasonal events and business key performance indicators with the flexibility based on the requirements of the business. Additional inclusions in the monthly Pharmacy Group Manager visit are:

ADDITIONAL BENEFITS OF BEING A PHARMACY ALLIANCE PARTNER ALLIANCE MEMBER A Partner Alliance Pharmacy gives you the opportunity to invest in a diverse range of sites and locations with multiple site ownership available. In addition, owners benefit from lifestyle flexibility, giving you the ability to step back from the day-to-day running of the pharmacy while continuing to enjoy the success and rewards of owning a pharmacy. A Partner Alliance membership can be suitable if you want to take time off to travel or need more time with your family. It can also be suitable for owners who enjoy dispensing and counselling patients but don’t want the stress of managing a business. Whatever your reason, you can rely on our team of experts to take care of your store while you take care of your needs. Even if you’re looking for a passive investment in pharmacy or are interested in an alternative to selling your business, Pharmacy Alliance Partner Alliance is the perfect solution.

•

Procedural & Financial checks

•

Planning for the month/quarter and year

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Reviewing reporting and implementing strategies to improve

At Pharmacy Alliance we are helping make pharmacy ownership affordable.

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Team management, including recruitment and team meetings

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Maximising Pharmacy Alliance deals/ programs.

With our ongoing growth and expansion plans, we can help you become a working partner with ownership options available.

"You can rely on our team of experts to take care of your store while you take care of your needs." GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 55 : AUGUST/SEPTEMBER 2017

For more information on how to become a Pharmacy Alliance member, email enquiries@pharmacyalliance. com.au or call the Member Support Office on 03 9860 3300.

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BUSINESS

FIVE COMMON

Leasing Mistakes BY PHILLIP A. CHAPMAN Phillip A. Chapman is the Founder of Lease1 and Director of MiLease Managing Lease Intelligence, both of which are endorsed Gold Cross Member Services.

WHEN IT COMES TO THE COMPLEXITIES AND OUTCOMES OF DEALING WITH YOUR RETAIL LEASE, THERE REMAIN FIVE COMMON MISTAKES, WHICH WHEN WE STEP BACK FROM THE PROCESS, APPEAR FUNDAMENTALLY BASIC; HOWEVER, THESE POINTS ARE CONTINUALLY OVERLOOKED.

But, before we harp on these, it is timely that all pharmacies review how they hold their lease(s). I raise this due to a couple of events: one just recently and another coming in 18 months. The recent event was the “Hail Mary” move by a Retail Franchisor (Sumo Salad), where a company which only held their leases was put into voluntary administration. Although this is not a new strategy to have a very adjusted structure around the Lessee entity to provide some protections if things go sour, it does require a high level of advice from legal and accounting practitioners to set up and maintain, and it is not for everyone. Regardless of how the pharmacy ownership and management is structured, there needs to be careful consideration as to how the lease is held and by whom, as the Lessee entity can take many forms (i.e. a person, a trust, a holding company etc.). The event on the horizon is the International Accounting Standards Board (IASB) introduction of regulation IFRS 16 on leases. Under IFRS 16 there is no longer a distinction between finance and operating leases. Leases will now bring to account a right-of-use and lease liability onto their balance sheets for all leases. IFRS 16 becomes effective for reporting periods beginning on or after 1 January 2019 (and will be known as AASB 16 leases by the Australian Accounting Standards Board). These two events should give you cause

to question how you hold and deal with your current lease but, more importantly, how you deal with new leases. But that’s the complex stuff, and the majority are still getting the basics wrong:

MISTAKE 1. I DON’T NEED TO DO ANY RESEARCH. Regardless of any negotiations you enter into, research is required to establish the outcomes you need to achieve. In retail tenancy leasing, research is needed on your industry, your business, the shopping centre, the landlord and the current market.

MISTAKE 2. WAITING – NOT LEVERAGING TIME. Every lease has two common elements: a commencement date and, more importantly, an expiry date. Time can be your enemy or your friend. Make a conscious decision to leverage your negotiations. In most cases this means starting the process early. Don't be the one waiting for the Landlord to contact you, by then it's too late.

MISTAKE 3. NOT KNOWING THE NUMBERS. Make it your business to know how the real estate you lease performs for your business — not how you perform for the real estate (landlord).

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 55 : AUGUST/SEPTEMBER 2017

Know your occupancy cost percentage and sales per square metre ratios and how these compare to industry benchmarks.

MISTAKE 4. NOT KNOWING THE COSTS. Before you look at any new lease, renewal, or option, have a clear and concise knowledge of your fitout/refurbishment costs. Ensure your lease term exceeds the time needed to pay off (amortise) any fitout and set-up costs. Also include these costs when negotiating your commercial terms so you are clear on the return on investment (ROI) and leveraging the rental rate.

MISTAKE 5. NO MEETING/FILE NOTES. At each lease negotiations meeting, phone call, or e-mail … make notes. Keep a file in date order that is easy to reference. After each meeting, confirm your understanding of the points back to those you meet or call. Continue after the lease has been entered into to maintain this file and continue with your notes — you never know when you will need to rely on these to protect your position. There are several more common mistakes made when dealing with your Lease and the Landlord/Centre Manager relationship, but the five above are the ones that we have seen cost the Lessees the most over the past 30 years in the retail property industry.

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BUSINESS

Empower Patients to Better Understand Their Medication: One Patient's Story CAITLIN PETERSON GuildLink Marketer and Mum

OVER 270 MILLION SCRIPTS ARE DISPENSED BY COMMUNITY PHARMACISTS EVERY YEAR, MAKING MEDICINE THE MOST FREQUENTLY USED MEDICAL TREATMENT IN AUSTRALIAi. AS A RESULT, A COMMUNITY PHARMACIST IS OFTEN THE LAST HEALTHCARE PROFESSIONAL TO INTERACT WITH A PATIENT BEFORE THEY TAKE THEIR PRESCRIBED MEDICATION. THIS MEANS THAT DESPITE BEING JUST ONE LINK IN A CHAIN OF HEALTHCARE PROFESSIONALS, PHARMACISTS ARE RESPONSIBLE FOR THE RELATIONSHIP THAT THEIR PATIENTS HAVE WITH THEIR MEDICATION AND ARE INFLUENTIAL IN THE MEDICATION-RELATED HEALTH BEHAVIOURS OF THEIR PATIENTS.

In acknowledgement of this, both the Pharmacy Guild of Australia and the Pharmaceutical Society of Australia (PSA) advocate that one of the central pillars of patient-centric care is patient empowerment and access to medication knowledgeii, advocating that community pharmacists should “provide tailored verbal and written information to ensure the consumer has sufficient knowledge and understanding of their medicines and therapeutic devices to facilitate safe and effective use”iii. Unfortunately, in some instances, patient empowerment and medication knowledge sharing is not the experience of patients — meaning, pharmacists aren’t providing adequate verbal and written information about the medication being dispensed. Recent Australian studies show that this trend can be linked to a variety of factorsiv: Some of the Factors Influencing Patient Empowerment and Sharing of Medication Knowledge: •

Consumer Medicines Information’s (CMI) perceived lack of value to the patient;

•

Healthcare professionals ambivalent about providing information as it may adversely affect patient adherence to medication;

•

Written CMI is too complex for the patient to understand;

•

Provision of information is lower in priority than other day-to-day patient care tasks.

As a non-medical professional and a patient, I would rather have the information than not, and after a recent experience, it is more important to me than ever to be a wellinformed, empowered patient and carer.

THIS IS MY STORY: In May, my 2-year-old had a barking cough, coupled with laboured breathing. I took him to the doctor and she prescribed a regime of Prednisolone syrup and Salbutamol inhaler. She wrote down the desired dose regime and gave me a printout outlining how to use a spacer to administer the Salbutamol inhaler. On the way home, I went to a pharmacy where I bought the medication and a spacer with accompanying infant facemask. That night I went to administer the Salbutamol inhaler to my already tired and unwell toddler, only to realise I couldn’t interpret the instructions the doctor had given me that afternoon. Did she mean four puffs (as in four breaths through the spacer), or four puffs (as in four doses of the inhaler)? I panicked — it was too late to call and ask. Four doses seemed excessive for such a small child, so I gave him one “dose” (four breaths, every four hours) and hoped that was right. By the evening of the next day his breathing didn’t seem to be getting any better and I became worried that I’d gotten the inhaler dosage wrong. I was so angry at myself

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 55 : AUGUST/SEPTEMBER 2017

for not paying proper attention to the doctor’s verbal dose instructions, and I was annoyed I hadn’t asked the pharmacist to interpret the written down dose regime. I needed help, so I packed up my son, grabbed the inhaler, doctor’s dosage instructions, and drove to another pharmacy in my local area. I wish I’d visited this pharmacy to start with, they were great. The on-duty pharmacist took the time to explain the doctor’s dosage instructions properly and showed me how to confidently administer the inhaler to a child under five. I wish I’d had this advice and help when the medication was first dispensed. Had I not been aware enough to be concerned that I might be misinterpreting the doctor’s dosage instructions, the outcome could have been worse. My son’s breathing could have gotten so bad we ended up in hospital, or I could have inadvertently given him an overdose. My experience highlights that you can’t always rely on the patient to ask for information. Sometimes they are busy or stressed, and sometimes they don’t realise they need to ask. In my case, it was both. I was stressed because I had an unwell child and I didn’t realise I wouldn’t know how to interpret the dosage instructions. As a Mum and a Patient, it’s important to me that I am empowered to know information about, and how to take, the medication my family and I are prescribed. I rely on my Pharmacist to share my desire to become medicine aware and put the same value on patient empowerment that I do.

BUSINESS

The Australian Commission on Safety and Quality in Healthcare advocates that patients have the right to “receive open, timely and appropriate communication about healthcare” in a way that can be easily understood. As the last healthcare professional to interact with the patient, community pharmacists are in a unique and powerful position to be able to empower Australian patients by providing government-approved and easy-tounderstand information about the medication they are taking.

•

WHAT CAN YOU DO TO EMPOWER YOUR PATIENTS?

•

Patient empowerment is about information and communication, starting at the point of dispense.

1. PROVIDE A CMI The Pharmacy Guild of Australia advocate that a CMI is the most reliable and easily understood source of medication information available to patientsv. While pharmacists are actively encouraged to provide a CMI when asked by the patient, there are guidelines outlined by the PSA that stipulate when a CMI should be provided. They includevi: •

When a medicine is first provided to the consumer;

•

When brand substitution occurs and it is deemed appropriate;

•

When the dosage form has been changed (e.g. from injection to tablet);

With each supply of medicine for which regular reinforcement of information may be required (e.g. the medication is cytotoxic, teratogenic, or there are major contraindications to the use of a medicine);

•

When the consumer has special needs;

•

At regular intervals for medicines used for long-term therapy (e.g. every six months, or on dispensing the last repeat of a prescription with five repeats); When the pharmacist has received advice that a sponsor has made significant changes to the CMI.

Providing information about medication to patients at point of dispense doesn’t always mean providing a printed CMI to the patient. As digital health opportunities continue to evolve in Australia, accessing medicine information electronically is becoming more prevalent vii. Pharmacists can email the patient a CMI through their dispense or patient services software, share a link to an approved online information source like ebs.tga.gov.au or medicines.org.au, or invite the patient to access medicines information through a pharmacy patient app like myPharmacyLink.

2. TALK TO THE PATIENT Research shows that patients appreciate receiving verbal information in addition to a printed CMI. The PSA advocates that a printed CMI does not replace the value of a patient medication counselling session at the point of dispense. Using the CMI document as a guide, the PSA recommends during a counselling pharmacists shouldvi:

•• Highlight parts which are particularly relevant to that consumer’s needs;

•• Use the CMI leaflet in an interactive manner and encourage the consumer to read and seek clarification as necessary;

•• Provide further relevant information (e.g. about the disease or the approved PI).

3. ACTIVELY ENCOURAGE PATIENTS TO ASK ABOUT THEIR MEDICATION Many patients aren’t aware that consumer medicine information and medication counselling is available through their pharmacy. Initiatives like the Pharmacy Guild of Australia’s ‘Ask your Pharmacist’ actively promote patient empowerment and medication knowledge through their patient-facing campaigns and website — askyourpharmacist.com.au — but there is more that can be done instoreviii. Displaying instore promotional material like posters increases the likelihood of patients leaving your pharmacy with the knowledge that will help them take their medication effectively and safely. In an effort to address this need, GuildLink have developed a range of ‘CMI Awareness’ instore and digital assets to improve patient awareness about consumer medication information, medication knowledge, and encourage patients to ask their pharmacist. As a patient and a mum, I ask that when you are next dispensing medication that you take the time to talk to the patient about their medication, provide them with a CMI and encourage your patient to take an active appreciation for medications’ impact on their health. You have the opportunity to influence your patients’ relationship with their medicine, helping them to live healthier more medication adherent lives.

Contact the GuildLink Team to receive the CMI Awareness instore and digital assets, free of charge. GuildLink Team e: marketing@guildlink.com.au p: 02 8222 4444

REFERENCES: Page 7, https://www.guild.org.au/__data/assets/pdf_file/0026/4868/ahealthyfuturebrochure.pdf https://www.guild.org.au/__data/assets/pdf_file/0026/4868/ahealthyfuturebrochure.pdf iii Page 20 https://www.psa.org.au/downloads/standards/professional-practice-standards-v4.pdf iv ‘Mechanisms to maintain the currency of approved Product Information (PI) and Consumer Medicines Information (CMI) v Consumer Medicines Information – reliable information, May 2016 < https://www.guild.org.au/__data/assets/pdf_file/0025/5659/consumer-medicines-information.pdf> vi Consumer Medicines Information and the pharmacist, page 2 - http://www.psa.org.au/download/ent/uploads/filebase/guidelines/member-only-guidelines/consumermedicine-information-and-the-pharmacist.pdf vii Pharmacy Guild – Pharmacy Innovations in eHealth - Fact Sheet, http://guild.org.au/docs/default-source/public-documents/issues-and-resources/Fact-Sheets/pharmacyinnovations-in-ehealth.pdf?sfvrsn=0 viii http://askyourpharmacist.com.au/ i

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 55 : AUGUST/SEPTEMBER 2017

BUSINESS

Blame it on the Rain: Wet Weather Boosts Sales for Asthma and Allergy Treatments MARK BLITENTHALL Associate Director Nielsen

WINTER AND SPRING 2016 WAS ONE OF THE WETTEST PERIODS AUSTRALIA HAS SEEN FOR A NUMBER OF YEARS. THE WET CONDITIONS STIMULATED HIGH NATURAL GROWTH AND PROMOTED THE SPREAD OF POLLEN-CONTAINING GRASSES, RESULTING IN A PARTICULARLY BAD SEASON FOR ASTHMA AND ALLERGY-RELATED CONDITIONS.

Sales tracking data from QuintilesIMS showed that over November/December 2016, sales for asthma treatment products increased by 25% versus the prior year in Victoria. The wet weather also triggered a rise in allergy and hay fever remedies which increased by 3.3% on last year’s allergy season (early September through to the end of January), driven by Nasal Anti-Allergy products (up 17.9%) and Nasal Corticosteroids (up 5.6%).

that address ailments requiring specialist advice from a trusted expert are the ones that the pharmacy channel needs to really leverage to differentiate them from the rest of the market. As witnessed during the Victorian thunderstorm crisis in November last year, when Australians experience health challenges, they trust their local pharmacy to be able to step in at short notice with the right product and advice to restore them to health.

While antihistamine tablets grew at a slower pace, sales for its three major brands provided the strongest contribution to the category including Telfast (up 8.7% on prior year), Zyrtec (up 6.3%) and Claratyne (up 6%). Allergy season was very different across the states. Victorian sales for the allergy and hay fever category increased by 19% on last year — a contrast to the other states that recorded a decline in sales. Victoria went from having 27% of national sales in 2015 to generating almost a third (32%) of national sales last year, to bring it in line with the value of sales in NSW. The trend difference highlights the difficulty in predicting where and when hay fever spikes are likely to strike, making inventory management a key consideration for this category. Unlike allergy treatment products, asthma treatments were up significantly across most states with SA, NT and ACT all showing the highest levels of growth. However, once again, Victoria (with growth of 12%) was the clear leader, driving over half (56%) of all category value gains — adding weight to the argument that Victoria experienced an unusually intense allergy season last year. While allergy remedies might be a small category relative to other OTC categories, it, along with categories such as analgesics and gastro-intestinal remedies, is a key destination category for pharmacy. Categories GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 55 : AUGUST/SEPTEMBER 2017

With seasonality being a significant factor, it is important for pharmacists to be prepared to deal with allergy-related conditions, particularly during key times of the year. While there is a clear upswing in sales between early September and the end of January, the impacts of weather can alter exactly when the season hits, and it is important that product availability and range can withstand the unpredictability of the season.

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HEALTH

Oral Care

The Role of Sugar and Diet JOYCE HADDAD Accredited Practising Dietitian

Joyce Haddad is an Accredited Practising Dietitian and Accredited Nutritionist with a Masters in Personal Training. Joyce graduated with a Bachelor of Nutrition & Dietetics (Honours) and is currently conducting her PhD with UniSA and the CSIRO. Joyce is also the Director of A Dietitian's Mission (adietitiansmission.com), where she expresses her passion for health and wellbeing through private practice and the media.

SOMETHING WE DONâ&#x20AC;&#x2122;T APPRECIATE ENOUGH IS HOW IMPORTANT DENTAL HEALTH ACTUALLY IS. OUR TEETH AND GUMS MAY BE A SMALL PART OF OUR BODY, BUT THEY ARE VERY IMPORTANT TO GENERAL HEALTH. WITHOUT PROPER DENTAL HEALTH, WE RISK TOOTH DECAY, GUM DISEASE, AND EVEN BONE LOSS. FURTHERMORE, THE STATE OF OUR DENTAL HEALTH CAN OFTEN SIGNAL SYSTEMIC PROBLEMS, INCLUDING CARDIOVASCULAR DISEASE, DIABETES, GASTROESOPHAGEAL REFLUX AND MORE. SO, IF OUR EYES ARE THE WINDOWS TO OUR SOUL, THEN OUR MOUTH IS THE WINDOW TO OUR HEALTH!

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 55 : AUGUST/SEPTEMBER 2017

HEALTH

It is well known that added sugar found in chocolates, lollies and sugar-sweetened drinks is bad for teeth because it causes dental decay. More than 1 in 3 Aussie adults suffer from this completely preventable disease. However, there are other dietary factors that come into play as well. Start by trying these five simple tips:

1. REDUCE ADDED SUGAR INTAKE When we say sugar, we mean all forms of it, including sucrose, glucose, fructose, lactose, high fructose corn syrup and maltose. Why is sugar so bad for teeth? A continuous intake of sugar promotes the perfect environment for cariogenic bacterial growth in our mouths, which increases the likelihood of dental caries and its associated problems. An environment high in cariogenic bacteria produces an acidic environment, which in turn can result in the demineralisation of tooth enamel. It is important to note here, that amount and frequency of sugar consumption are both important. This is where soft drinks, fruit juices, vitamin waters and cordials become the culprits. Sipping sugar-sweetened beverages provides repeated hits of sugar on the teeth. On top of this, soft drinks are highly acidic and thus promote demineralisation. Therefore, foods and drinks containing added sugar should be consumed at an absolute minimum, and infrequently, to reduce risks of lost enamel by dental erosion. On the other hand, foods that contain natural sugar such as milk and fruit, can actually counter potential damage in teeth. These core foods are less cariogenic, thanks to their vitamin, mineral and phytonutrient content.

2. LOAD UP ON FRUIT AND VEG Like we need another reason to eat vegetables! Well, we have one: vitamin C in fruits (and vegetables) promotes periodontal health, and assists with remineralisation of demineralised enamel. The high fibre content in fruits and vegetables can also slow periodontal disease progress, while their phosphate and phytate contents have beneficial cariostatic properties.

3. EAT DAIRY FOODS Although milk and dairy foods contain the natural sugar lactose, their calcium content actually assists with the remineralisation of enamel, disassociating dairy food from dental erosion. In particular, cheese actually stimulates strong salivary flow, which neutralises the pH of the mouth after sugar consumption. So, it’s a good idea to eat some cheese after foods containing sugar!

the teeth. Therefore, chewing gum containing xylitol after meals can decrease the risk of cavities forming. But don’t go overboard because even though it won’t harm your teeth, it can cause gas and bloating. So, now that we know how important nutritious food is for oral health, follow these recommendations and you’ll be well on your way to beautiful pearly whites: •

Limit foods that are high in added sugar, such as biscuits, cakes, lollies and chocolate.

•

Choose water as your main drink and avoid sweetened and acidic drinks such as fruit drinks, cordials, soft drinks, vitamin waters, energy drinks and sports drinks. Use a straw with acidic drinks to help minimise acid contact with teeth, and ensure children over the age of 1 are drinking out of sippy cups rather than bottles.

•

Enjoy a well-balanced diet, including a range of foods from the core food groups like fruits, vegetables, whole grains, lean meats and dairy foods.

•

Ensure you include foods that aid in preventing tooth decay, like cheese, apples and xylitol-containing chewing gum.

4. DRINK SOME GOOD OL’ WATER Drinking plenty of fluoridated tap water, where available, is encouraged to strengthen and protect teeth against decay. The mineral fluoride helps to prevent decalcification in our bodies by promoting calcium absorption. Fluoride also acts topically on teeth to promote their surface health, and helps promote the remineralisation of enamel. Getting enough fluoride is actually more important than reducing sugar when it comes to preventing dental cavities! Therefore, for adults, fluoridated water is best. For children, milk and water are the preferred drinks (out of sippy cups rather than bottles). Sugar-sweetened beverages, particularly soft drinks, should be avoided by everyone, especially between meals.

5. MAKE FRIENDS WITH XYLITOL Xylitol, found in foods such as apples and sugar-free gum has many positive properties. Consumption increases saliva production which prevents cariogenic bacterial growth in our mouth, thus remineralising enamel and assisting in the removal of food particles from

For individualised dietary advice that builds on the above information, refer customers to an Accredited Practising Dietitian (APDs). APDs are University-trained to provide evidencebased advice, tailored to the specific needs of each person. To locate your local APD, search ‘Find an Accredited Practising Dietitian’ at daa.asn.au or freecall 1800 812 942.

"A continuous intake of sugar promotes the perfect environment for cariogenic bacterial growth in our mouths, which increases the likelihood of dental caries and its associated problems."

Furthermore, chewing on raw fruit and vegetables, such as apples, carrots celery etc. may clean teeth to a certain extent. Eating a raw vegetable or fruit after a meal can help remove material that has adhered to the surface of the teeth. Plus, apples contain naturally occurring xylitol, which is a bonus!

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HEALTH

PROBIOTICS:

a Novel Therapy for Anxiety & Depression? KATE ELLIS B.Pharm Cert IV TAE Professional Practice Pharmacist, National Guild Intern Training Program The Pharmacy Guild of Australia, Queensland Branch

“A HEALTHY MIND IN A HEALTHY BODY” IS A TRANSLATED LATIN PHRASE BY ROMAN POET, JUVENAL, AND IS WIDELY REFERENCED IN SPORTING AND EDUCATIONAL CONTEXTS TO DESCRIBE THE ASSOCIATION BETWEEN HEALTHY EATING AND EXERCISE AS AN IMPORTANT PART OF MENTAL AND PSYCHOLOGICAL WELLBEING. ON THIS NOTE, EMERGING EVIDENCE OVER THE PAST DECADE HAS SUGGESTED THAT A HEALTHY GUT MICROBIOME IS A NOVEL THERAPEUTIC TARGET FOR THE TREATMENT AND/OR PREVENTION OF MOOD AND ANXIETY DISORDERS, AND SUBSEQUENTLY, A HEALTHY MIND1.

THE GUT TALKS There is a recent field of research which highlights that direct biochemical signalling exists between the gastrointestinal tract and the central nervous system, which is named the ‘gut–brain axis’1,2. The gastrointestinal tract is connected to the brain via 200 to 600 million neurons3 and this microbiome– gut–brain axis is said to be essential for maintaining homeostasis, including that of the central nervous system4. Furthermore, modulation of this gut–brain axis is linked to behaviour and the stress response4,5. The human microbiome is under constant dynamic evolution throughout the host’s lifetime, and populations exist on numerous sites of the body (e.g. skin, oral cavity, the vagina and the gastrointestinal tract)4. To get a picture of how large the adult microbiome actually is in relation to the gut, consider that there are approximately 1014 microorganisms residing inside the gastrointestinal tract (which is roughly 10x the amount of human cells in the body)4. The majority of said 1014 microorganisms are bacterial, comprised of around 500 to 1000 different species which can vary in number, diversity and stability across the human population4. This

microbiome is also sensitive to a wide range of influences such as infection, diet, stress and pharmacological intervention4.

MOOD DISORDERS AND THE GUT Major depressive disorder is a complex psychiatric condition that will affect up to 20% of the population at some point in their life, with most pharmacological treatments focusing on altering neurotransmitter activity in the brain2. These conventional treatments (i.e. antidepressants) can cause adverse effects such as nausea, sedation, headaches and sexual dysfunction2. The link between depression and probiotics is suggested by Logan and Katzman6 who state that the beneficial bacteria which are lowered in states of stress and illness could influence depression by a number of mechanisms. This is evidenced by the Tannock and Savage7 study, which found that stressed mice had lower levels of lactobacilli compared with control mice. Further to this point, Liu et al.8 note that stress is considered to be correlated to anxiety and depression. Additionally, recent study findings suggest that stress leads to anxiety and depression by altering the gut microbiota8.

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ARE PROBIOTICS THE SOLUTION? There is consequently a growing body of evidence that probiotics can be utilised to normalise the microbial imbalance associated with psychological conditions9. Probiotics are defined as: live microorganisms that improve the host intestinal microbial balance when administered in adequate amounts6,10. In studies, probiotics have been found to decrease oxidative stress and lower systemic inflammatory cytokines6, both of which have been associated with mood disorders11. Furthermore, there is robust evidence in animal studies that have found improvements in mood, anxiety and cognition by altering neurotransmitter activity through the administration of probiotics2. Other animal studies have observed changes in the metabolism and biosynthesis of the imperative neurotransmitter, serotonin2. Additionally, preclinical studies have found that psychological changes such as reduced anxiety and depressive-like behaviours were observed in rodents that were treated with probiotics12. Conversely, in regards to human trials, the recent double-blind, randomised, placebo-controlled trail by Romijn et al.11,

HEALTH

"It is clear from the convincing evidence in preclinical studies that further research is warranted to determine the efficacy of probiotics in treating depressive symptoms and anxiety."

found no significant difference between probiotic and placebo groups across any of the psychological outcome measures. Despite this, however, the authors noted several distinct limitations to their study (e.g. treatment-resistant sample) and strongly encouraged future studies in this area11. Furthermore, a 2017 systematic review of several trials involving humans found that the majority of studies had positive results on all measures of depressive symptoms2. Of note though, the dosing, duration of treatment and strain of probiotic varied significantly between studies2. Researchers have thus queried that the beneficial effects of probiotics on depression and anxiety may be strain specific1.

and depression in at-risk populations, given the role that microbiota plays in neurodevelopment of brain networks related to emotion regulation1.

Nonetheless, the research in this area indicates that probiotics may improve symptoms associated with major depressive disorders by decreasing levels of antiinflammatory markers and/or increasing serotonin2. Such a novel treatment option in this space has the potential to reduce the latency, stigma and side effects associated with conventional antidepressants2. Studies have also suggested that human microbiota could be a target for the prevention of anxiety

REFERENCES:

FUTURE IMPLICATIONS In summary, it is clear from the convincing evidence in preclinical studies that further research is warranted to determine the efficacy of probiotics in treating depressive symptoms and anxiety2. The ideal strain of probiotic still requires clarification, as well as the treatment duration and dose to provide the best outcomes in humans2. Who knows, a healthy gut may really be the answer to a healthy mind.

Slyepchenko A, Carvalho A, Cha D, Kasper S, McIntyre R. Gut Emotions – Mechanisms of action of probiotics as novel therapeutic targets for depression and anxiety disorders. CNS Neurol Disorder Drug Targets. 2014, 13(10):1770–86. 2 Wallace C, Milev R. The effects of probiotics on depressive symptoms in humans: a systematic review. Ann Gen Psychiatry. 2017, 16(14):1–10. 3 Furness J. Novel gut afferents: intrinsic afferent neurons and intestinofugal neurons. Auton Neurosci. 2006, 125:81−85. 4 Moloney R, Desbonnet L, Clarke G, Dinan T, Cryan J. 1

The microbiome: stress, health and disease. Mamm Genome. 2014, 25:49–74. 5 Clarke G et al. The microbiome–gut–brain axis during early life regulates the hippocampal serotonergic system in a sex-dependent manner. Mol Psychiatry. 2013, 18(6):666–73. 6 Logan A, Katzman M. Major depressive disorder: probiotics may be an adjuvant therapy. Med Hypotheses. 2005, 64(3):533–8. 7 Tannock G, Savage D. Influences of dietary and environmental stress on microbial populations in the murine gastrointestinal tract. Infect Immun. 1974, 9:591−98. 8 Liu X, Cao S, Zhang X. Modulation of gut microbiotabrain axis by probiotics, prebiotics, and diet. J Agric Food Chem. 2015, 63(36):7885–95. 9 Saulnier D, Ringel Y, Heyman M. The intestinal microbiome, probiotics and prebiotics in neurogastroenterology. Gut Microbes. 2013, 4(1):17−27. 10 Hill C, Guarner F, Reid G et al. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014, 11:506−14. 11 Romijn A, Rucklidge J, Kuijer R, Frampton C. A double-blind, randomized, placebo controlled trial of Lactobacillus helveticus and Bifidobacterium longum for the symptoms of depression. Aust N Z J Psychiatry. 2017, 1–12. 12 Luo J, Wang T, Liang S, et al. Ingestion of Lactobacillus strain reduces anxiety and improves cognitive function in the hyperammonemia rat. Sci China Life Sci. 2014, 57(3):327–35.

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HEALTH

Helping People Living with Dementia to No Longer Feel Alone SARAH KLEVEN Communications Officer Alzheimer's Australia

MORE THAN 413,000 PEOPLE IN AUSTRALIA ARE CURRENTLY LIVING WITH DEMENTIA AND ROUGHLY 244 PEOPLE JOIN THIS NUMBER WITH A DIAGNOSIS EVERY DAY. YET, DESPITE THE HIGH NUMBER OF AUSTRALIANS SHARING A DEMENTIA DIAGNOSIS, THOSE LIVING WITH DEMENTIA AND THEIR CARERS ARE AMONG THE LONELIEST PEOPLE IN AUSTRALIA.

A survey of 1,500 people conducted by Alzheimer’s Australia in 2016 found that those with dementia are more than twice as likely as the general public to have high rates of loneliness.

dementia the opportunity to remain engaged with their community and lead meaningful lives.

The survey also found that people with dementia are more than twice as likely not to have a confidant, and not to see any friends. Carers also have significantly fewer relationships than the general public, and are considerably lonelier.

Dementia is an umbrella term for more than 100 neurological conditions, which affect memory, thinking, behaviour and emotion. It is the second leading cause of death in Australia, and the leading cause of disability and dependency among older Australians.

As the prevalence of dementia in Australia increases and the number of people living with dementia is set to hit 1.1 million by 2056, it is imperative that there is a greater awareness and understanding of dementia in Australia so that people living with dementia don’t feel so alone.

It is a condition that has been noted in people for hundreds of years; however, it was relatively rare before the 20th century as fewer people lived to old age in pre-industrial society.

This September is Dementia Awareness Month and Alzheimer’s Australia hopes to break down any fear, stigma and barriers around dementia to create more inclusive, kind and accepting communities where people with dementia, their families and carers can feel well-supported and less isolated and alone. With over 70% of Australians admitting to knowing very little about dementia and almost half the population not realising the disease is fatal, Australians are being encouraged to get involved and find out more about dementia during Dementia Awareness Month. This year’s theme for the month is ‘You are not alone’ and across the country, Alzheimer’s Australia hopes to show Australians that we can all play a part in giving people living with

WHAT IS DEMENTIA?

It was not until the mid-1970s that dementia began to be described as we know it today. Dementia is a progressive disease of the brain that mainly affects older people — although it is not a normal part of ageing. The most common form of dementia is Alzheimer’s disease, which accounts for 50–60% of all cases. Other forms of dementia include vascular dementia, frontotemporal dementia, and dementia with Lewy bodies.

WHAT ARE THE SIGNS AND SYMPTOMS OF DEMENTIA? The boundaries between the different types of dementia are not necessarily distinct and everyone experiences each type differently. Symptoms range from behavioural change,

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difficulty processing conversations, memory problems, confusion over everyday tasks, apathy, withdrawal, depression, and reduced concentration.

IT MAY NOT BE DEMENTIA Many conditions have symptoms similar to dementia, so the presence of some of the above symptoms does not necessarily mean it is dementia. Strokes, depression, alcoholism, infections, hormone disorders, nutritional deficiencies and brain tumours can all cause dementia-like symptoms. Many of these conditions can be treated. A correct diagnosis is important.

CONSULTING A DOCTOR AT AN EARLY STAGE IS VITAL Only a medical practitioner can diagnose dementia. A complete medical assessment, including the patient's medical history, physical examination, laboratory tests, neuropsychological or cognitive testing, brain imaging and psychiatric assessment may identify a treatable condition and ensure that it is treated correctly, or it might confirm the presence of dementia. Early diagnosis can lead to improved outcomes for a person with dementia and their family, with access to treatment, support and services to assist. As pharmacists have a close connection and regular contact with their customers, they are able to play a vital role in assisting with the detection of possible dementia and changes in a person’s cognition or ability over time.

HEALTH

An estimated

413,000 people have

Dementia in Australia

THE ROLE OF THE PHARMACIST Pharmacists are in a position to recognise the early symptoms of dementia and encouraging their customers to seek an early diagnosis. Having a trusted, long-term relationship with customers may allow pharmacists to approach a difficult topic with sensitivity and tact. The focus of most pharmacists’ interactions with their customers understandably centres on medication management. Polypharmacy is a reality for many elderly customers being treated for multiple medical conditions, so there are often opportunities as part of usual counselling with dispensing to ask open-ended questions regarding side effects and potential problems with cognition. This can serve as a helpful introduction to difficult conversations about memory loss, problems with cognition and the importance of educating customers and their families about the benefits of early detection and diagnosis. Pharmacists can also highlight the value of medication review with their customers — advising the importance of a comprehensive medicines check where problems of memory loss, forgetfulness or cognitive impairment become a concern. For more pharmacistspecific information and accredited CPDs, visit detectearly.org.au or scan this code.

SERVICES PROVIDED BY ALZHEIMER’S AUSTRALIA INCLUDE: •• EDUCATION Our highly skilled educators offer specialised dementia education programs for people with dementia, family members and carers of people living with dementia.

•• CARER SUPPORT GROUPS Our carer support groups provide an environment in which carers of people with dementia can discuss issues with other people in a similar situation.

•• COUNSELLING Alzheimer’s Australia provides a discreet and confidential counselling service for people living with dementia, their families and friends.

•• NATIONAL YOUNGER ONSET DEMENTIA KEY WORKER PROGRAM Provides customised information and support, to improve the quality of life for people with younger onset dementia — a diagnosis of dementia under the age of 65.

For information, advice and support phone the NATIONAL DEMENTIA HELPLINE

1800 100 500

The National Dementia Helpline is an Australian Government funded initiative.

Or visit the Alzheimer’s Australia website for comprehensive information about dementia, care information, education, training and other services offered. FIGHTDEMENTIA.ORG.AU

WHAT WE DO • Alzheimer’s Australia is the charity for people with dementia and their families and carers. • As the peak body, it provides advocacy, support services, education and information. • An estimated 413,000 people have dementia in Australia. • This number is projected to reach more than 1.1 million in 40 years. We advocate for the needs of people living with all types of dementia, and for their families and carers, and provide support services, education and information.

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BUSINESS

"There is an imperative that all health professionals caring for a patient work collaboratively for optimal care."

WEâ&#x20AC;&#x2122;RE ALL

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BUSINESS

IN THIS TOGETHER SHEFALI PAREKH National President NAPSA

For full access to media releases and position statements, please visit our website: napsa.org.au E: president@napsa.org.au P: 0422 394 905

THE NATIONAL AUSTRALIAN PHARMACY STUDENTS’ ASSOCIATION (NAPSA) WISH TO HIGHLIGHT THE IMPORTANCE OF BRIDGING THE VERY CLEAR AND CONTENTIOUS GAP IN PRACTICE BETWEEN HEALTHCARE PROFESSIONALS.

NAPSA President, Shefali Parekh, sat down with Advanced Practice Pharmacist, Debbie Rigby, and Australian Medical Students’ Association (AMSA) President, Rob Thomas to hear their thoughts.

SHEFALI: WHAT ARE THE BENEFITS OF A MULTIDISCIPLINARY HEALTHCARE TEAM? DEBBIE: With ageing population and the complexity of medication management in patients with multiple chronic conditions, there is an imperative that all health professionals caring for a patient work collaboratively for optimal care. Medications are an integral part of care for people with chronic conditions. Pharmacists need to take responsibility for medication management in collaboration with the consumer, their general practitioner and other health providers. We know points across the continuum, for example discharge from hospital, have high medication errors. Evidence suggests that 230,000 hospital admissions per year are medication-related and at least half are avoidable. New medicines are also a trigger point for multidisciplinary care, especially between prescribers and dispensers. Collaborative Home Medication Reviews and Residential Medication Management Reviews have really been the success story of professional programs in the Community Pharmacy Agreements. They have been the only sustainable programs with high level evidence of impact and outcomes — and they are collaborative with GPs and other community carers. Chronic disease such as diabetes, asthma, COPD, hypertension, cardiovascular disease, gout etc. can all be better managed in a multidisciplinary care team.

ROB: There are many benefits to a multidisciplinary healthcare team. I think it’s the epitome of patient-centred care in many senses, and aligns all the teams’ goals towards what is best for the patient. In a system that requires many moving parts and specialists in different areas, multidisciplinary approaches can lead to crosschecking and ensure that the timeline of patient care is optimised.

SHEFALI: HOW CAN/DO PHARMACISTS CONTRIBUTE TO THIS TEAM? DEBBIE: Pharmacists can contribute significantly to better medication management as part of a multidisciplinary team, regardless of the place of work, such as community pharmacy, hospital pharmacy, consultant pharmacists, pharmacists in general practice. A good example is inhaler device technique and adherence. Evidence suggests both are poor and can be greatly improved through pharmacist interventions, support and care. We need to shift the focus to patientcentred care rather than the technical act of dispensing. The profession needs to acknowledge the benefits of pharmacists across the continuum of care, and work collaboratively within the profession; as well as with GPs and other health professionals. Community pharmacists should use software as a patient record and not just a record for remuneration. Community pharmacies and all pharmacists should embrace and be proactive with ‘My Health Record’ and recognise the benefits of having access to a shared health summary, and discharge summaries. Pharmacists working in general practice will have access to the GPs’ patient records — this is invaluable and critical to practising at the top of our skills and knowledge. Without this

information, we are only guessing and not looking at the complete picture in order to make a clinical decision or judgement. We need to forget the 'internal competition' within the profession, and be mature enough to recognise the emerging career pathways for pharmacists as part of the primary healthcare team. We need leadership from individuals and organisations, and show respect to our colleagues and peers.

ROB: Pharmacists can offer advice regarding drug administration timing or interactions that a doctor may not have considered, and they can be especially helpful when the administration instructions are complicated. Their added experience of the patient in a different setting can add to the whole picture of a patient, and in a community setting, pharmacists can be really useful for communication with patients and are at times the first port of call for some unwell people. NAPSA currently collaborates with other healthcare students via the Red25 Health Students Blood Challenge campaign initiative. We compete with the Australian Medical Students’ Association (AMSA), the Australian Dental Students' Association (ADSA) and Student Paramedics Association (SPA) to make the most blood donations. This example of us students working together now, and nationwide, means it becomes more ‘commonplace’ when we are in the workforce. NAPSA believes this is paramount to reduce the increasing possibility of a dissenting future. A united multidisciplinary approach to healthcare not only means that professional relationships are strengthened, but also that the overall health outcomes of our patients are better than what is currently achieved. An environment where all healthcare professionals join together is the future and NAPSA stands by this future.

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HEALTH

WOMEN’S HEALTH WEEK 2017

It’s Time to Put Your Health First

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 55 : AUGUST/SEPTEMBER 2017

HEALTH

JANET MICHELMORE AO Executive Director of Jean Hailes for Women’s Health

Women’s Health Week (WHW) has been a permanent feature on the Australian health event calendar since 2013, taking place every year in the first week of September. Founded by national not-for-profit organisation, Jean Hailes for Women’s Health, WHW aims to get women talking about the health issues that matter most to them. No matter how tricky the topic, Jean Hailes aims to help women get rid of the ‘elephant in the room’; hence the event’s elephant logo. The week-long campaign combines an online event with public and community-run events supported by Jean Hailes. Events range widely from morning teas in the office to health promotion stands in pharmacies. WHW has gone from strength to strength every year as the public and health care professionals recognise the benefit of taking time out to think about women’s health issues. In 2016, a record 23,000 participants — more than double the previous year’s — took part in over 620 events around the country, while a further 12,600 registered to have free health-related content emailed to them every day of WHW. All material supplied during the campaign is evidence-based and reviewed by Jean Hailes medical experts. As Jean Hailes for Women’s Health gears up for its fifth annual WHW from 4–8 September, the event is already looking to eclipse last year’s numbers.

NATIONAL HEALTH SURVEY “If a woman is in good health, her family, community and the society around her also benefit.” – Dr Jean Hailes Every year, Jean Hailes conducts a national survey of women and health professionals, asking them key questions relating to health. The largest of its kind, survey results are used to drive the content for WHW. This year, more than 10,000 respondents offered insights into

topics such as mental health, heart health and bone health. The results of the survey will be announced just prior to WHW. Last year’s survey revealed that the two biggest barriers for women not maintaining a healthy lifestyle is ‘lack of time’ (29% of respondents) and ‘health not a priority’ (22%). Yet, Dr Jean Hailes believed that if women were kept well, then everyone around them would also be better off. It’s a view backed by plentiful research. So, in the spirit of Jean, for this year’s Women’s Health Week, Jean Hailes for Women’s Health is asking women to put themselves first. Too often, women put the wellbeing of family and friends ahead of their own. Yet, if we think of the safety instructions on an aircraft — to put your own oxygen mask on before helping others — Jean’s insight becomes clear; if you’re not looking after yourself, eventually those around you will also be impacted. That's why the health of the ones we love starts with us. Women’s Health Week is the time for women to put themselves first, for just one week, and start making positive changes that can last a lifetime.

EVENTS AND ACTIVITIES It’s easy to be a part of Women’s Health Week. Health professionals can create their own event, such as an information session or a fun group exercise class in the park. There’s a ‘How to host an event’ guide for download, which features loads of tips, and plenty of other downloadable materials such as invitations, name tags and conversation starters. Event guests can also receive a free gift bag full of goodies, including the latest issue of the Jean Hailes magazine and a special fold-out information book. Consumers can also simply sign up to join WHW and receive the daily content, and they can also choose to host their own event.

WHO IS JEAN HAILES? Founded in 1992, Jean Hailes for Women’s Health was named in honour of the work and enduring legacy of Dr Jean Hailes AM. Jean was a Melbourne general practitioner with a far-sighted vision to improve the quality of women’s lives and give them practical information based on the best available evidence. In 1971, Jean established the first women’s health clinic in Australia — and one of the first in the world — dedicated to midlife and menopause. On her passing, a group of Jean’s former colleagues vowed to continue her work and legacy. Today, Jean Hailes for Women’s Health is spread across four sites in Melbourne and helps women across Australia with all aspects of their physical and emotional health and wellbeing. Jean Hailes has two clinics that see more than 14,000 patients a year, a research unit (in conjunction with Monash University) and an education and translation unit that takes the current research and clinical findings and creates practical, free resources for women. This year the organisation celebrated its 25th anniversary.

SIGN UP NOW Women’s Health Week is free, informative and entertaining. It’s something that everyone in the community can get behind. It’s an opportunity for pharmacists around the country to connect with women and talk about important health issues in a relaxed and engaging way. For more details and information about Women’s Health Week, and to sign up or register an event, visit womenshealthweek.com.au. For more details and information about Jean Hailes for Women’s Health, visit jeanhailes.org.au.

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WHAT IS WOMEN'S HEALTH WEEK?

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6 months travelling around Australia with my fiancé (now husband). We visited 64 national parks! It was great to travel around our own country in our early 20s when most other travellers doing what we were doing were from overseas or grey nomads!

I decided to become a pharmacist because… I did work experience in pharmacy when I was at school and enjoyed it as I could see the important role the pharmacist played in the local community. I also wanted a job that would give me flexibility in the future with working hours when I had a family.

How I keep myself updated on the market news…

I have been working as a pharmacist for…

Talking with my team of pharmacists and meeting with colleagues. Also reading pharmacy journals on a rainy weekend!

20 years with Terry White Chemists and now Terry White Chemmart.

Over the next three years in pharmacy, I predict… I believe there will be a consolidation of pharmacies and pharmacy brands over the coming years. There will be increased pressure on dispensary margins and we will no longer be able to rely on dispensary alone. We need to become better and smarter retailers and also look for niche opportunities in our local areas.

What I like best about my job is… I love that every day is different and brings a different challenge. I love not just being a pharmacist but the added responsibility of being an owner/manager. I enjoy encouraging and motivating my team to be the best they can be and working together to achieve great results!

If I could give any advice to someone starting a career in pharmacy, it would be…

My favourite hobbies are...

Find yourself a good mentor and work hard, and have a great work ethic that makes you stand out from the crowd! Align yourself with a forward thinking pharmacy brand and be ready to adapt to change or you will get left behind!

Any travel with my family (and drinking coffee!).

My favourite book is… Steve Jobs - he was an extraordinary and inspirational man.

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stay healthy through that hard part of their life. We have many repeat purchases of SkinB5.”

SkinB5 supports Australian community pharmacies with a range of training and patient information, enabling pharmacists and pharmacy assistants to facilitate patient suitability for acne treatment with SkinB5’s Complete Acne Control System.

“Receiving a patient’s prescription for acne prompts us to speak to the customer about the SkinB5 range. Giving out ‘Ask your Pharmacist about SkinB5’ brochures is of importance, as people return with the brochure after deciding to embark on using SkinB5 in the privacy of their home. We find that they return to speak specifically to a pharmacist. Those who have been on antibiotics and topicals, and take SkinB5 in addition to their script treatment, see a rapid improvement. What captures the acne patient’s attention, is that SkinB5 is treating acne from the source. Our SkinB5 sales increased quite markedly using the Pharmacy Support Program. I enjoy referring the patient to the pharmacy assistants for a skin management plan, encouraging pharmacy team action. Pharmacists are missing an opportunity if they don’t take up the SkinB5 Pharmacy Support Program. When customers get results, it’s the best advertising we can use for referrals. SkinB5 PSP is a great tool to win the acne control category back to pharmacy.”

SkinB5 offers a professional Pharmacy Support Program (PSP) to support 6CPA clinical intervention. Pharmacists are already seeing immense success using SkinB5's free Pharmacy Support Program (PSP). Katrina Kana, BPharm, Owner Chemist Outlet Wallsend, Wallsend NSW “SkinB5’s PSP has increased my patient care, and customer loyalty and goodwill. It’s great to be able to offer an alternative to Vitamin A derivative medication with the many side effects. Our young customers like to have a regime and SkinB5 step by step system is easy to follow. Both supplements and skincare work together to bring best patient outcome. In this age group, it’s not just an acne treatment: SkinB5 supports immunity and reduces stress, so they

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``PHARMACY ALLIANCE KEEPING MEMBERS RELEVANT ONLINE At Pharmacy Alliance we believe it is important to connect our members with customers. In an age where digital communications is leading the way, we believe that using social media marketing is a great way to get the word out about local pharmacy business, increase customer reach online, connect with customers live and keep up to date on industry trends and changes. Even more important than the exposure, it provides the opportunity to grow relationships with our target audience.

• • • •

The Social Media Program offers participating Members a monthly content plan consisting of a range of catalogue promotions, health awareness days, general health and lifestyle tips and much more.

•

Benefits of the Pharmacy Alliance social media program include: •

Set up of a Facebook page or Administration right.

•

Updated cover, profile and images added to posts. Monthly social media plan. Facebook advertising for our member pharmacy. Health, Seasonal, Product, and Retail news posts for all members. Specific Alliance Pharmacy and Catalogue posts for dual members. Monthly reports of the Facebook page sent to Members e-mail. Alliance Pharmacy branded stores linked to the master Alliance Pharmacy page. Help and support.

With its extensive reach and dynamic functionality, there are very few businesses that couldn’t benefit from having a presence on Facebook.

``STRATPHARMA Stratpharma is a Swiss based dermatology company. With over 10 years in operation, Stratpharma products are in over 50 countries worldwide. The Stratpharma product range in Australia is used by leading dermatologists, plastic surgeons, cosmetic surgeons and physicians. Now Stratpharma products are also available through leading Australian pharmacies so pharmacists can also provide their customers with the most professional products to treat wounds, scars and stretch marks. Stratamed is a gel dressing that can be used on open wounds such as surgical incisions, minor burns, cuts and grazes. It is a flexible film-forming wound dressing that provides faster wound

healing and helps prevent abnormal scar formation. Strataderm is a professional scar treatment for scars both old and new. Strataderm helps to soften and flatten raised scars, reduce redness and discolouration, and relieves the itching and discomfort associated with scars. Strataderm is easy to apply once daily. Stratamark, unlike cosmetic and moisturising products, is a topical medical device that is clinically proven for the prevention and treatment of stretch marks. Stratamark is easy to apply once daily. For more information on Stratpharma and their product range please visit stratpharma.com or call 1800 567 128.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 55 : AUGUST/SEPTEMBER 2017

PRODUCT SPOTLIGHT ``NEW DELICIOUS AND HEALTHY ISOWHEY PROBIOTIC CHOCOLATE Numerous studies have for some time reported on health benefits of consuming 1-2 squares of dark chocolate a day. Now, there’s even more reason to enjoy dark chocolate in moderation, with new IsoWhey Probiotic Chocolate – a delicious, 99% sugar-free chocolate snack with the added benefits of probiotics and vitamin D3. IsoWhey Probiotic Chocolate contains a strain of beneficial bacteria, which contributes to normal, healthy gut flora1. The new probiotic chocolate also contains vitamin D3, for supporting the normal function of the immune system2, and inulin, a prebiotic fibre2. New IsoWhey Probiotic Chocolate is 99% sugar free, contains no artificial colours or flavours, and is also gluten free. Each bar contains 10 billion CFU of probiotics plus 25% of the RDI of vitamin D3, making it a healthy and delicious daily snack or dessert alternative. Key features and benefits: • • • • • •

99% sugar free, for a guilt-free chocolate snack; Contains 10 billion CFU of friendly bacteria, which contribute to a healthy digestive flora; 25% of the recommended daily intake of vitamin D, to support healthy bones and immune function; High quality Ghanaian cocoa, rich in antioxidants, including flavanols, catechin and epicatechin3; Free from gluten, artificial colours and flavours; Delicious dark chocolate flavour.

RRP: $15.95 (12 x 12.5g bars) Stockist: 1300 650 455 >> isowhey.com.au

REFERENCES: 1 Hill C, Guarner F, Reid G, et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement of the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol 2014;11(8):506-514. 2 Braun L, Marc C. Herbs and Natural Supplements, 3rd edition, 2010. Churchill Livingstone Elsevier: Sydney. 3 Latif R. Chocolate/cocoa and human health: a review. Neth J Med 2013;71(2):63-68.

``SKINB5 - NATURAL ACNE TREATMENT SYSTEM THAT ACTUALLY WORKS Utilising the power of vitamin B5, SkinB5’s innovative Natural Acne Treatment System combines supplements and skincare to eliminate and treat the underlying causes of Acne from the INSIDE OUT.

RRP from $29.95 to $56.95 FREE Pharmacy Support Program & Stockist enquiry: 1300 088 655 or email pharmacy@skinb5.com

5 Key Actions of SkinB5 to control acne: Sebum control, hormone balance, strengthening immunity, stress relief and cell renewal. >> skinb5.com

``STRATADERM GEL FOR PROFESSIONAL SCAR THERAPY Strataderm is a self-drying, non-sticky, transparent silicone gel formulation for the treatment of old and new scars. It is used to: • • • •

Soften and flatten raised scars1; Relieve the itching and discomfort associated with scars1; Reduce the redness and discoloration of scars1; Prevent abnormal and excessive scar formation2.

Strataderm is a once-a-day treatment that is easily applied to all areas of the skin, including exposed areas like the face, neck and contoured areas of the body. Strataderm is suitable for pregnant women, breast-feeding mothers, children, and people with sensitive skin. REFERENCES: 1 Tobola J. Dermat Estetyczna 2004;35(6):323–328 2 Monstrey S et al. JPRAS 2014;1–9 GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 55 : AUGUST/SEPTEMBER 2017

>> strataderm.com

A L ICE SPR INGS, NOR THERN TERR ITORY

2 2 N D S E P T E M B E R - 1S T O C TO B E R

"A FES TI VAL OF LIGHT IN V ITES YOU TO E XPERIENCE THE OL DES T CONTINUOUS CULTURE ON E A R TH LIK E NE V ER BEFORE." Step into a spectacular world of light and sound where contemporary and traditional Aboriginal stories and artwork are brought to life under the night sky on an unprecedented scale. Illuminating 2.5 kilometres of the epic 300-million-year-old MacDonnell Ranges and spilling into Alice Springs Desert Park, Parrtjima will be a breathtaking outdoor gallery experience presenting local artwork, culture and stories, with interactive installations the whole family can enjoy. The sheer scale of the lighting on the MacDonnell Ranges makes Parrtjima Australia’s longest-ever light show installation. With ten nights to explore this free festival, make sure you don’t miss out!

MEANING OF PARRTJIMA Pronounced ‘par-chee-ma’, Parrtjima means ‘lighting up’ and conveys two meanings: the physical ‘lighting up’ of an object, and also in the context of ‘lighting up’ with meaning or understanding, to shed light on a subject. ‘Parrt’ means ‘no idea’ or ‘no understanding’, while ‘Parrtjima’ is the imparting of meaning and understanding.

parrtjimaaustralia.com.au

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HEALTH CALENDAR

HEALTH CALENDAR A

T/ SEP T EMB E

JEANS FOR GENES DAY 4th of August >> jeansforgenes.org.au Jeans for Genes is the iconic fundraising campaign of Children’s Medical Research Institute. Each year, Australians unite by wearing their favourite jeans and outdoing each other with crazy denim outfits, and donating money or purchasing merchandise, to support genetic research. On the first Friday in August each year workplaces, schools and streets become a sea of denim in a united stance against childhood disease. Every dollar raised on the day helps scientists at Children’s Medical Research Institute discover treatments and cures, to give every child the opportunity to live a long and healthy life.

DENTAL HEALTH WEEK 7th – 13th of August >> ada.org.au Dental Health Week, which takes place in the first full week of August, is the Australian Dental Association’s major annual oral health promotion event. Its aim is to educate Australians about the importance of maintaining good oral health in every aspect of their lives. It has three main objectives: •

Promote oral health education and awareness in the general community;

•

Motivate and educate dental professionals to promote oral health;

•

Encourage ongoing collaboration within the dental profession.

This year Dental Health Week, which runs from 7th to 13th August, is focusing on the significant way that hormones can play havoc with a woman’s oral health, an especially important topic in light of a recent study that revealed that many women are unaware of the significant impact that various life stages have on the health of their teeth and gums. The reality is that major life events like pregnancy, puberty, menstruation and menopause, dramatically affect the state of your dental health if you are a woman.

0 R2

NATIONAL EOS AWARENESS WEEK 6th – 12th August >> ausee.org Eosinophilic gastrointestinal disorders (EGID) occur when eosinophils (pronounced ee-oh-sin-oh-fills), a type of white blood cell, are found in above-normal amounts within the gastrointestinal tract. Eosinophils are important in your body’s defence against parasitic infections (e.g. worms). However, they are also involved in allergy. In some individuals, eosinophils accumulate in the gut in response to food and/or airborne allergens and can cause inflammation and tissue damage. The abnormal amounts of eosinophils can occur in the: • Oesophagus (eosinophilic oesophagitis) EoE; • Stomach (eosinophilic gastritis) EG; • Duodenum (eosinophilic duodenitis); • Small intestine (eosinophilic enteritis); • Large intestine (eosinophilic colitis) EC; • Throughout the gastrointestinal tract (eosinophilic gastroenteritis) EGE.

HAEMOCHROMATOSIS AWARENESS WEEK 7th – 13th of August >> haemochromatosis.org.au Haemochromatosis is the most common genetic disorder in Australia. About 1 in 200 people of northern European origin have the genetic risk for haemochromatosis. People with haemochromatosis absorb too much iron from their diet. The excess iron is stored in the body. Over time this leads to iron overload. We all know that not enough iron causes health problems but few realise that for some, too much iron is also a problem. If undetected and untreated, the excess iron can cause organ or tissue damage and can potentially result in premature death. Haemochromatosis tends to be under-diagnosed, partly because its symptoms are similar to those caused by a range of other illnesses. Both sexes are at risk from haemochromatosis. Women tend to develop the condition later in life because of blood loss during child bearing years. However some women will develop symptoms at an early age. The good news is that if haemochromatosis is detected before damage occurs, it can be easily treated and is no barrier to a happy and successful life.

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HEALTH CALENDAR

BE MEDICINEWISE WEEK 22nd – 28th of August >> healthdirect.gov.au Be Medicinewise Week is an annual national awareness week that promotes safer and better use of medicines for all Australians. This year's theme, 'Take Charge!' will be held 22nd - 28th August and will focus on how Australians should be in control of their medicines by: • • •

R U OK DAY 14th of September >> ruok.org.au

Asking the right questions; Asking the right people; Following the right advice.

This event aims to encourage Australians to take charge of their health by being medicine wise as well as to raise awareness on the importance of having conversations about medicines.

R U OK? Day is our national day of action dedicated to encouraging everyone to connect with the people they care about and giving them the skills to have a conversation with someone they’re worried about any day of the year. Taking part can be as simple as asking your friends, family and colleagues, “are you ok?”.

INTERNATIONAL CHILDHOOD AWARENESS MONTH Month of September >> cancer.org.au September is International Childhood Cancer Awareness Month, a time when cancer organisations around the world put the spotlight on children's cancer and the need to improve diagnosis, treatment and outcomes. Sadly around 710 children aged 0-14 are diagnosed with cancer in Australia every year and 100 will die from the disease. Cancer Council Queensland funds and manages the Australian Paediatric Cancer Registry – one of only a few national clinical registers of childhood cancer in the world. The registry records clinical and treatment information on all children diagnosed with cancer in Australia. Figures from the registry show that childhood cancer death rates in Australia have decreased by nearly 40 per cent over the past 15 years. However, cancer remains the most common cause of disease-related death for children aged 1-14 in Australia, and data from Associate Professor Claire Wakefield at the University of NSW has shown that 81 percent of childhood cancer survivors develop at least one lifechanging mental or physical health issue after cancer treatment they received as a child. This highlights the need for further research and support services for families affected.

IDIOPATHIC HYPERSOMNIA AWARENESS WEEK 4th – 10th of September >> hypersomnolenceaustralia.com Idiopathic Hypersomnia (IH) is a rare neurological sleep disorder. In 1976 Bedrich Roth coined the term "Idiopathic Hypersomnia" and defined two forms of the disease, Monosymptomatic (previously referred as “without long sleep”) manifested by excessive daytime sleep/sleepiness, and Polysymptomatic (previously referred to as “with long sleep”). This is characterised by exceptionally deep and abnormally long nocturnal and daytime sleep, great difficulty awakening and "sleep drunkenness" (sleep inertia). Recent research supports the findings of previous studies that suggest Polysymptomatic Idiopathic Hypersomnia is distinct and unique and is in fact an independent sleep disorder of Monosymptomatic Idiopathic Hypersomnia. The research showed that the clinical features of Monosymptomatic Idiopathic Hypersomnia were more closely related to those found in Narcolepsy without cataplexy (Type 2 Narcolepsy).

Cardiomyopathy Association of Australia Ltd CARDIOMYOPATHY AWARENESS WEEK 3rd – 10th of September >> cmaa.org.au Cardiomyopathy is a term used to describe a disease of the heart muscle. The name means: CARDIO - heart, MYO - muscle, PATHY disease. Currently it is not known how many people in Australia have the condition, but a general estimate suggests that perhaps 1 in 500 may be affected. The main types of cardiomyopathy are: • Dilated or 'enlarged' heart, the most common form; • Hypertrophic or 'thickened muscle'; • Arrhythmogenic right ventricular, a more unusual form associated with arrhythmias; • Restrictive or 'stiff' heart, the least common; • Ischaemic, medically induced. Warning symptoms or complaints include shortness of breath, fatigue and a feeling of lethargy, palpitations, fainting attacks and sometimes chest pains.

NATIONAL HEALTH AND PHYSICAL EDUCATION DAY 6th of September >> achper.org.au In celebration of the health and wellbeing of young children across Australia, ACHPER will hold its annual National Health and Physical Education (HPE) Day in 2017 on Wednesday September 6. The nationwide event is designed to raise awareness of the value of HPE in the Australian Curriculum and highlight the important role it plays in the learning and development of children, the benefit to all schools, and the educative value to the wider community. 2017 will focus on encouraging children to get involved as part of the theme celebrated over three consecutive years being; Good for Children, Good for Schools, Good for Communities. Teachers and Principals are encouraged to get involved by holding activities or events for students during the week or on the day itself, while parents are urged to get involved and commit to a 'Parent Pledge' to see them encouraging physical activity at home.

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BUSINESS DIRECTORY

Would you like to advertise in our Business Directory? Contact Ida Tornvall on Ph: 07 3040 4415 or Email: production@goldx.com.au

Business Directory 15 Castlereagh Street Sydney NSW 2000 Tel: 02 9233 8975 >> advangen.com.au

113 Wicks Road North Ryde NSW 2113 Tel: 1800 2387 4276 >> aftpharm.com

12 Mowbray Terrace East Brisbane QLD 4169 Tel: 07 3363 7100 >> alere.com

Level 1, AMA House 42 Macquarie Street Barton ACT 2600 Tel: 02 6278 8900 >> fightdementia.org.au

Level 3, 10 National Circuit Fyshwick ACT 2609 Tel: 02 6070 8950 >> glucojel.com.au

Level 3, Suite 301 151 Castlereagh Street Sydney NSW 2000 Tel: 1300 647 492 >> guildlink.com.au

1 Gam Avenue Currimundi QLD 4551 Tel: 1300 019 028 >> ha.org.au

Level 4, 15-17 Park Street South Melbourne VIC 3205 Tel: 03 9903 8999 >> jeanhailes.org.au

9/65 Tennant Street Fyshwick ACT 2609 Tel: 02 6163 6700 >> acp.edu.au

1/8 Phipps Close Deakin ACT 2600 Tel: 02 6189 1200 >> daa.asn.au

20B Ferric Street Virginia QLD 4014 Tel: 07 3268 7377 >> doseinnovations.com

NAPSA 40a Birmingham Rd Alexandria NSW 2015 Tel: 03 9855 2655 >> napsa.org.au

Level 2, Building B 11 Talavera Road Macquarie Park NSW 2113 Tel: 02 8873 7000 >> nielsen.com

73-79 Beauchamp Road Matraville NSW 2036 Tel: 1300 722 269 >> pccarx.com.au

Level 4, 111 Coventry Street South Melbourne VIC 3205 Tel: 03 9860 3300 >> pharmacyalliance.com.au

Guild House, 40 Burwood Road Hawthorn VIC 3122 Tel: 03 9810 9999 >> guild.org.au Level 1, Unit 3 321 Kelvin Grove Road Kelvin Grove QLD 4059 Tel: 1300 766 369 >> lease1.com.au

Level 10, 52 Collins Street Melbourne VIC 3000 Tel: 03 9853 7933 >> medici.com.au

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Suite 5-6, 307 Maroondah Highway Ringwood VIC 3134 Tel: 1300 088 655 >> skinb5.com

Level 1, 174 Willoughby Road Crows Nest NSW 2065 Tel: 1800 567 007 >> stratpharma.com

Natural Acne Treatment System that ACTUALLY WORKS! Utilising the power of Vitamin B5, SkinB5 combines supplements and skincare to eliminate and treat the underlying causes of Acne from the INSIDE OUT.

#SkinB5SuccessStories Pharmacist Saki Kusakabe, Tweed Heads, NSW

#SkinB5SuccessStories Former Pharmacy Assistant Luis Barnett, Sunshine Coast, QLD

SkinB5 offers a FREE Pharmacy Support Program. Under the 6CPA, a Clinical Intervention may be able to be claimed for this program! Contact pharmacy@skinb5.com

Follow #skinb5 @skinb5 visit www.skinb5.com to learn more

CPD planning

ain’t nobody got time for dat the australian college of pharmacy The September 30 CPD deadline is fast approaching. Don’t waste time planning CPD the hard way. Get with the fast, easy system that satisfies the Board’s requirements. Don’t be caught out. Be CPD audit ready.

Join the College TODAY. 1 year for $345.40. info@acp.edu.au (02) 6188 4320 www.acp.edu.au