ITK April/May 2014 - Edition 35 by Gold Cross Products & Services

ISSUE #35 : APRIL / MAY 2014

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 a y ’ s C o m m u n i t y P h a r m a c i s t

IN THE KNOW

• eye care in pharmacy • COSTS – MANAGING, NOT JUST CUTTING • CPD – THE DIABETIC EYE

• OSTELIN PREGNANCY ESSENTIALS feature interview • New – Patient-centred Care • TRAINING & EDUCATION

DOUBLE ACTION

CONTENTS PROFFESSIONAL REVIEW 32 There is no cure – But prevention is always better

APP – SUN AND SUCCESS

SPECIAL FEATURE 10 CPD – The Diabetic Eye 14 Ostelin Pregnancy Essentials 28 First in Aid Product Reference Guide

OTHER ARTICLES 20 Category Review – Eyecare in Pharmacy

BY SEAN TUNNY

26 Mystery Shopper – A Symptom based request

Editor, Gold Cross Products & Services Pty Ltd

34 Professional Review – Macular Disease Foundation

As this edition of ITK goes to print, APP 2014 is being held on the Gold Coast, with delegates enjoying an event punctuated by an outstanding line-up of speakers in a terrific venue. The theme for this year’s APP is Towards 2020: Priming pharmacy for patient focused care with a host of conference

GUILD NEWS 4 News from the National Pharmacy Guild President 18 Guildcare – Patient Adherence Programs

DOWN TO BUSINESS

speakers presenting insightful information

24 Costs – Managing not just cutting

on this key element of pharmacy over the next

38 How to find candidates without placing a job ad

6 years. The planes have landed, and cars are heading north and south as the excitement and bustle of APP is NOW! We will feature a summary of APP in our next edition of ITK, suffice to say in advance that the event is a resounding success—thank you one and all. I recently had the opportunity to speak

40 Getting the Engine Room Working for your Business 44 Patient-centered Care

AFTER HOURS 51 A 470km epic bike ride for a remarkable cause

with Michael Owen, a brain cancer survivor, whose story, featured in this edition of ITK,

REGULARS

is truly remarkable and inspiring. He recently

46 Product Spotlight

rode 25 laps around one of Brisbane’s hilliest terrains to raise money for cancer. The must-

53 60 Seconds Interview

continuing professional development module,

54 Health Calendar

on Ostelin pregnancy.

48 What’s new and Company news

read components of this edition of ITK are our company news and updates, and feature

55 Classifieds

We hope APP was productive, informative and successful for you and thank you for your ongoing support of this publication—readers, contributors and advertisers alike. Best regards, Sean Tunny Editor

PLEASE USE THIS PUBLICATION TO KEEP YOUR PHARMACY IN THE KNOW.

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

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PUBLISHED BY: Gold Cross Products & Services. PO Box 505 Spring Hill Qld 4004. Contact Candice Radford Email: Candice.radford@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 constitue 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.

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NEWS FROM THE GUILD PRESIDENT

Great Work in Community Pharmacies George Tambassis National President of The Pharmacy Guild of Australia

A few months ago the Guild put out a call for real stories about the great work done by community pharmacies. It seemed to us that sometimes the things that seem ordinary and run-of-the-mill to those of us in the industry are of interest and benefit to the wider community.

Through this edition of ITK I’d like to say a big ‘thank you’ to those pharmacists and pharmacy staff who responded with some great stories. For example, one story was sent to us by the non-pharmacist husband of a Western Australian pharmacist, Lena Fonseka Massie. The story told of how Lena effectively saved the life of an elderly female patient named Joy, who fell ill during a visit to the pharmacy at the height of a devastating hailstorm. Lena’s efforts included a sharp clinical intervention and courage that included helping the patient to wade through kneedeep floodwater to attend the nearest hospital emergency department. In the coming days, Joy, her husband and her children wrote thank you cards and called Lena at the pharmacy to thank Lena for being attentive enough to notice that Joy was slightly breathless, for caring enough to offer to take her blood pressure, and for saving

a wife and a mother’s life. Joy called Lena her ‘guardian angel’. Lena’s husband Darrell wrote to us: ‘Lena has not told anyone this story other than to close friends and family and chose to allow me to tell it now, as the public needs to be reminded that pharmacists very often are unsung heroes. In Lena’s words, “Pharmacy is not just a destination to get medications, or cheap vitamins and toilet paper. From the little clinical interventions we make on a daily basis that reduce side effects experienced by patients, enabling them to continue their therapy, or preventing serious medication interactions, to outright saving people’s lives. We are at the forefront of patient care, the ones with the most patient interaction, and hence are in the best position to know our patients, to help our patients and to save our patients’ lives.” ’ Another story came to us from David Whittle, a fifth-generation pharmacist.

“The challenges that we bear at first with some of these clients, only magnifies the satisfaction that I eventually get from seeing how far these clients progress over time.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

David wrote: ‘The community service that gives me by far the most professional satisfaction is the methadone service provided to about 30 clients out of our community pharmacy in Brisbane. ‘I admit some clients can be very difficult at first but with encouragement, clearly defined supervision and treating them with human respect, they will and do respond. ‘I get great satisfaction from seeing these clients become emotionally and medically stabilised and get their lives back together and become productive members of the community. ‘We have many examples of the pride and joy that some of these clients share with us. ‘We have past clients that drop in from time to time to thank us for looking after them, and tell us how well they are doing at work and that they are still drug free after so many years. ‘The challenges that we bear at first with some of these clients, only magnifies the satisfaction that I eventually get from seeing how far these clients progress over time’, David Whittle wrote. The Guild regards the lifting of the perception of community pharmacy as a valued part of the health system as a major priority of our advocacy work, particularly in the lead-up to the next Community Pharmacy Agreement. So please keep those stories coming in.

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Evidence-based CM offers healthy opportunity for Community Pharmacy.

harmacist and noted researcher, Associate Professor Lesley Braun, joins the Blackmores Institute with a vision to improve pharmacists’ access to quality, evidence-based knowledge and education about complementary medicines. As Director of the Blackmores Institute, Braun highlights some key opportunities for pharmacy in 2014, and how improved knowledge of complementary medicine can lead to better health outcomes. Q: What is the Blackmores Institute? The blackmores institute delivers accredited education to pharmacists to support the quality use of complementary medicines. our advisory team provides further advice on evidence and efficacy, along with addressing queries on therapeutic dosage and potential medicine interactions. The blackmores institute also facilitates the conduct of research into the safety and efficacy of complementary medicines, with a range of leading universities and research bodies. We support research into new integrated health

models in pharmacy so that the knowledge base grows and pharmacists are better equipped to meet the needs of their customers.

Q: What are the opportunities you see for pharmacy in 2014? i was involved in several australian surveys which identified that pharmacy customers want more information from their pharmacists about complementary medicine safety and efficacy. Some of this research also showed that pharmacists recognise they have an important role in providing advice about the appropriate use of complementary medicine, but often don’t have the confidence to discuss them or knowledge to draw on to promote patient safety and maximise the potential benefits.

Q: How can the Blackmores Institute help pharmacists to take advantage of these opportunities? The blackmores institute is a vehicle to support pharmacists so that they can become more knowledgeable about complementary medicine, be alerted to the latest research and undertake accredited and practical education. To make this possible we provide medicine interaction charts, access to a helpline/support team for more technical questions, a bi-weekly newsletter that highlights research and other relevant issues and run educational events to help pharmacists translate evidence into practice and integrate complementary healthcare into the total patient care model. To find out more, visit blackmoresinstitute.org and:

Blackmores Institute Symposium 2014 25 July - 26 July 2014 The Westin, Sydney

for early bird offer

blackmoresinstitute.org

Research Advisory Services Provider

• • • •

register for updates download interactions guide access evidence based resources register for the blackmores institute Symposium

Blackmores Institute Symposium 2014 Integrating Natural Medicine into Community Pharmacy – An Evidence-Based Approach

Adjunct Associate Professor Lesley Braun PhD Director Blackmores Institute National Institute of Complementary Medicine (University Western Sydney). Adjunct Senior Research Fellow at the Monash/Alfred Psychiatric Research Centre

Dr Charlie Teo MBBS, FRACS Neurosurgeon Founder, Cure for Life Foundation

Associate Professor Treasure McGuire PhD

Adjunct Associate Professor Greg Mapp

Assistant Director of Pharmacy, Mater Health Services, Brisbane Conjoint Senior Lecturer, School of Pharmacy, University of Queensland. Associate Professor of Pharmacology, Faculty of Health Sciences & Medicine, Bond University

BPharm (Hons), GradDip Herbal Medicine, GradDip Clinical Nutrition

Professor Charlie Benrimoj Head of School and Professor of Pharmacy Practice Graduate School of Health UTS

How comfortable and confident are you when answering patient enquiries about complementary medicine? Register for Blackmores Institute Symposium

blackmoresinstitute.org

Earn

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An accredited educational event for pharmacists looking to integrate complementary healthcare into their total patient care. • Updates on latest research and main therapeutic areas where complementary medicine can be a successful adjunct therapy • Delegates receive an exclusive toolkit with resource information for use in clinical practice • Program of distinguished speakers, featured above, together with: - International guest speaker Professor Candy Tsourounis from University of California - Dr Raymond Schwartz, eminent neurologist - Associate Professor Parisa Aslani from Sydney University - Liesl Blott from Curtin University - Associate Professor Antigone Kouris, Dept of Dietetics and Human Nutrition, La Trobe University, and - Prof Alan Bensoussan, National Institute of Complementary Medicine

Profits from the event will be donated to the Cure for Life Foundation

25 July - 26 July 2014 The Westin, Sydney

The scientific program has been developed with the expert advice of the National Institute of Complementary Medicine, University of Western Sydney

Full program available at blackmoresinstitute.org

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Send two pharmacy assistants to PA2014 and receive a FREE APP2015 registration for your pharmacy (value = $760)* This is an excellent opportunity for you or a member of your staff to attend the Australian Pharmacy Professional Conference and Trade Exhibition (APP) 2015 for free. *Limited to one (1) registration per pharmacy, offer is for a full registration excluding Gala Dinner.

Offer is limited so hurry!

TO REGISTER VISIT: www.pharmacyassistants.com Like ‘Australian Pharmacy Assistants’ on Facebook for the latest news and information

IN THE KNOW

CONTINUING PROFESSIONAL DEVELOPMENT

“Diabetic retinopathy (DR) is characterised by exudates, microaneurysms, haemorrhages, and the proliferation and overgrowth of new blood vessels. All of these changes can lead to permanent vision loss and ultimately to blindness.”

The Diabetic Eye WHAT CAN THE PHARMACIST DO? BY Margaret Robinson B.Pharm.Hons, Dip Comp Sci – AM Pharmacy Guild of Australia

Eye structures

Epidemiology – Based on the 1999–2000 Australian Diabetes, Obesity and Lifestyle Study, approximately one million Australians are estimated to have diabetes with the number expected to increase over the coming decade.

Risk of diabetic retinopathy The most common eye complication in type 2 diabetes is diabetic retinopathy (DR). It is characterised by exudates, microaneurysms, haemorrhages, and the proliferation and overgrowth of new blood vessels. All of these changes can lead to permanent vision loss and ultimately to blindness. The Australian Diabetes, Obesity and Lifestyle Study found that 21.9% of people with known diabetes had developed retinopathy, but even more worrying was the study’s finding that 6.2% of newly diagnosed diabetics already had signs of retinopathy.

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CONTINUING PROFESSIONAL DEVELOPMENT Obesity There are many risk factors that affect the rate at which diabetic retinopathy progresses. While some of these factors cannot be altered, some others—with the support of health carers and timely monitoring— can be improved and the progression of diabetic retinopathy can be slowed. This chart (left) lists the risk factors that are associated with the excessive progress of diabetic retinopathy.

Smoking Depression Protein in the urine

Risk factors that can be altered

High cholesterol Cardiovascular disease Uncontrolled hypertension Eating disorders Poor blood glucose control

Progression of retinopathy Diabetic retinopathy has four stages:

1 Mild nonproliferative retinopathy (mild NPR) At this earliest stage, microaneurysms occur. These are small areas of balloon-like swelling in the retina’s tiny blood vessels.

2 Moderate nonproliferative retinopathy (moderate NPR) As the disease progresses, some blood vessels that nourish the retina are blocked.

3 Severe nonproliferative retinopathy (severe NPR) Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.

4 Proliferative retinopathy (PR) At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss; however, they have thin, fragile walls, so if they leak blood, severe vision loss and even blindness can result.

Clinical signs of diabetic retinopathy

Normal vision

Vision with diabetic retinopathy

Vision with floaters

There are many clinical signs of diabetic retinopathy, but very few can be discerned by the patient alone. The patient may notice blurred vision, a loss of visual sharpness and an increase in the presence of ‘floaters’. Patients may also notice a distortion in their vision or some abnormalities in their colour vision, although these are rarer and usually not always noticed by patients.

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CONTINUING PROFESSIONAL DEVELOPMENT

Monitoring parameters for diabetic retinopathy Australian data reveal that approximately 22% of existing type 2 diabetes patients have retinopathy, and about 6% of newly diagnosed type 2 diabetic patients have retinopathy. Thus, these patients need to be encouraged to see their eye-care provider on a regular basis. Newly diagnosed patients should have an immediate examination with their eye-care provider. If no retinopathy is discovered, they should return for an examination every 2 years. If the retinopathy is more serious, then the patient may need to be monitored every 3, 6 or 12 months depending on the stage of retinopathy that exists in the patient. A patient who has a sudden unexplained drop in visual sharpness, or who has suspected proliferative diabetic retinopathy or macular oedema, should be referred urgently to an ophthalmologist within 4 weeks.

Time frames for eye examinations in patients with diabetic retinopathy 10 Type of diabetic retinopathy

Time frame for eye exam

Aboriginal & Torres Strait Islanders with diabetes

Every 12 months

Nonproliferative diabetic retinopathy Mild

Every 12 months

Moderate

Every 6 months

Severe

Every 3 months

Proliferative diabetic retinopathy

Within 4 weeks

Sudden loss of visual acuity

Within 4 weeks

Macular oedema

Within 4 weeks

“Australian data reveal that approximately 22% of existing type 2 diabetes patients have retinopathy, and about 6% of newly diagnosed type 2 diabetic patients have retinopathy.”

Role of the pharmacist in monitoring diabetic retinopathy The table below indicates a protocol for the monitoring of patients with type 2 diabetes to try to reduce the rate of progression of diabetic retinopathy.

Protocols for monitoring diabetic retinopathy Patient

Protocol

Following Action

Newly diagnosed diabetics • Patient presents with a new script for a diabetic drug at a pharmacy.

• Refer to optometrist for an eye exam. • Facilitate the appointment.

Ask patient to find out if they have DR and what stage it is at (mild, moderate or severe NPR or PR). • If not existent, record to refer back in 2 years. • If mild NPR, record to refer back in 12 months. • If moderate NPR, record to refer back in 6 months. • If severe NPR, record to refer back in 3 months.

Already diagnosed diabetics

• Check when patient last had an eye exam. • Check if patient knows what stage of DR they have.

• If patient has not had an eye exam for >2 years, refer and facilitate the appointment. • If patient does not know what level of DR they have, ask patient to find out if they have DR and what stage it is at (mild, moderate or severe NPR or PR). • If not existent, record to refer back in 2 years. • If mild NPR, record to refer back in 12 months. • If moderate NPR, record to refer back in 6 months. • If severe NPR, record to refer back in 3 months.

Patients who report sudden loss of visual acuity

• Refer urgently to an ophthalmologist.

• Facilitate appointment to ophthalmologist directly or via optometrist.

All diabetics • lipids

• Check when last had cholesterol tests.

• Refer if none done for >2 years. • Record test results. • If levels are high, check that lipid-lowering drug therapy or weight loss is being pursued.

All diabetics • blood pressure

• Do BP monitoring every month at pharmacy.

• Optimal systolic BP is <125 mm Hg. • Check with medical practitioner at what level they want the BP to be before patient is referred back for more treatment. • May be an advantage to have an ACE inhibitor in regimen.

All diabetics • weight

• Measure waist and BMI every month at pharmacy.

• Optimal waist measure is <102 cm for men and <88 cm for women. • Optimal BMI is <25. • Refer to a weight-loss program if either measure is outside of these parameters.

All diabetics • exercise

• Check amount of exercise patient does daily.

• Optimal exercise routine is 30–45 min of walking at least 3 times per week (with comfortable shoes to avoid neuropathy problems). • Refer to a gym with approval of medical practitioner if not exercising, or encourage walking and recording the amount of exercise done.

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CONTINUING PROFESSIONAL DEVELOPMENT

Delaying progression of diabetic retinopathy Blood glucose control In the seminal Diabetes Control and Complications Trial (DCCT) of type 1 diabetics it was found that keeping blood glucose levels within range (3.5–5.5) resulted in a 45% reduction in the progression to severe retinopathy. In the United Kingdom Prospective Diabetes Study (UKPDS) of type 2 diabetics it was found that tight glycaemic control with sulfonylureas and insulin resulted in a 21% reduction in retinopathy.

ASSESSMENT QUESTIONS

Blood pressure

Lipids One study found that disordered blood lipids may increase the risk of hard depositions in and around the macula. This study found that the lipid-reducing drug fenofibrate reduced the need for laser treatment in a large diabetes cardiovascular trial.

Other factors It has also been found that a reduction in the Body Mass Index (BMI) of overweight patients, regular exercise and a nutritional diet can reduce the progression of retinopathy.

Question 1. Which of the following is an ALTERABLE risk factor for developing diabetic retinopathy: a. anxiety b. depression c. race d. duration of type II diabetes

Question 2. Proliferative retinopathy: a. Develops in the early stages of retinopathy b. Is characterised by the development of microaneurisms in the retina’s tiny blood vessel system c. Many blood vessels are blocked, depriving several areas of the retina with their blood supply d. Is characterised by the growth of new blood vessels

Question 3. A patient, aged 55 years and a nonindigenous male, comes into the pharmacy having been initially diagnosed with type II diabetes. They are starting on their anti-diabetic medication. With regard to eye care of this patients you would recommend that they: a. have an initial eye examination by their general practitioner and then every 12 months thereafter b. have an initial eye examination by their optometrist/ophthalmologist and then every 12 months provided there is no

retinopathy is discovered on this first examination c. have an initial eye examination by their optometrist/ophthalmologist and then every 2 years provided there no retinopathy is discovered on this first examination d. have an initial eye examination by their optometrist/ophthalmologist and then every 6 months if retinopathy is discovered on this first examination

question 4. A diabetic patient comes into the pharmacy a little concerned about his eyes. He asks for a tube of Chlorsig (chloromycetin). You ask what signs of infection he has. What of the following symptoms would cause you to refer this patient immediately to his optometrist/ophthalmologist because you suspect diabetic retinopathy: a. a loss of visual sharpness and an increase in the presence of “floaters” b. eye itching and redness c. conjunctival swelling and redness d. increase in tears and pus from the eye

Question 5. Which of the following will reduce the progression of diabetic retinopathy if adequately controlled: a. diabetic nephropathy b. diabetic neuropathy c. lipid levels d. retinal hygiene

ANSWERS: Question 1 – b/ Question 2 – d / Question 3 – c / Question 4 – a / Question 5 – c

The UKPDS also found that tight control of blood pressure in type 2 diabetics (defined as BP values being less than 150/65 mm Hg) reduced retinopathy by 34%. Patients who achieved a systolic (upper-range) blood pressure of less than 125 mm Hg had significantly less progression to retinopathy. Angiotensin is expressed in the eye, and one study found that lisinopril reduced the progression of retinopathy when used for blood pressure over a 2-year period.

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TRAINING AND EDUCATION

“Surprisingly, while we get most of our vitamin D from the sun, there is a growing issue of Vitamin D deficiency in this country.”

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TRAINING AND EDUCATION

Ostelin Pregnancy Essentials BY SEAN TUNNY Editor, Gold Cross Products & Services Pty Ltd

Sanofi Consumer Healthcare engaged a panel of leading medical experts including Professor Peter R Ebeling MBBS MD, FRACP; Associate Professor Craig Munns MBBS, PhD, FRACP; and Associate Professor Glyn Teale MBBS, MD, FRACP to review evidence supporting important nutrients to encourage good health in pregnant women.

Based on scientific research, the panel recommended four core nutrients which are vital for a strong healthy pregnancy and baby development that may be difficult to get from diet and lifestyle alone. Nutrients include: Vitamin D, Folic Acid, Iodine and Omega-3. ITK recently had the opportunity to speak with Associate Professor Craig Munns, Paediatric Endocrinologist, Bone and Mineral Medicine at Westmead Children’s Hospital on this review of essential nutrients with specific application to the Australian community Pharmacists.

Editor: Given the added demands on the body during pregnancy, many expectant mothers are unable to get sufficient nutrients from diet and lifestyle alone, despite their best efforts. What were the findings of the panel regarding essential nutrients during pregnancy? Assoc. Prof. Munns: Given a developing foetus is solely reliant on their mother for essential nutrients, it’s vital that mothers are receiving the right nutrients through diet or supplementation, not only for the health

of both mother and baby during pregnancy, but also in the long term.

Australians only get around 10% of their vitamin D from dietary sources.

Pregnant women in Australia are generally able to access a reasonably balanced diet so may not need a full multivitamin. However, there are some nutrients people can find more difficult to get from diet and lifestyle alone such as Vitamin D, Folic Acid, Iodine and Omega-3. Pregnancy and lactation is a time of increased nutritional need, particularly for these four core nutrients.

Editor: In 2014 vitamin D deficiency remains a major health problem in Australia, who is most at risk?

Vitamin D helps keep muscles and bones strong. It is essential for the efficient utilisation of calcium by the body and modulates fracture risk in two ways: by decreasing falls and increasing bone density. Folic Acid helps reduce the incidence of neural tube defects in babies such as spina bifida. Iodine is critical for normal cognitive and hearing development while Omega-3 DHA supports foetal growth and brain, visual and nerve development. One of the key issues with Vitamin D is that it’s especially difficult to get adequate vitamin D from diet alone. In fact, most

Assoc. Prof. Munns: Surprisingly, while we get most of our vitamin D from the sun, there is a growing issue of Vitamin D deficiency in this country. A population based study lead by Professor Robin Daly found that nearly two in three women aged 25 and over have insufficient levels of vitamin D, which raises concern this may then also affect pregnant women. Those most at risk of vitamin D deficiency are people with little to no sun exposure including office workers and those who live in the southern states; individuals with naturally darker skin; people who cover up due to religious or cultural reasons; older adults and overweight individuals. Pregnant women also have an increased risk of deficiency which may have a serious impact on their babies’ development.

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TRAINING AND EDUCATION

“Maternal vitamin D levels are associated with optimal foetal skeletal development.”

Editor: What role does vitamin D play in both mother and child, and when should a pharmacist consider recommending a supplement to an expectant mother?

D supplement to not only promote a healthy pregnancy, but to ensure they’re providing their developing baby with enough nutrients to support proper bone formation.

Assoc. Prof. Munns: During pregnancy, Vitamin D is important for normal bone mineralisation and essential for the absorption and use of calcium and phosphorus from the small intestine. There is increasing interest in other potential health benefits of vitamin D for the mother. Vitamin D may also play a role in immune function, hormone regulation, muscle contraction, cell growth and the reduction of inflammation.

Editor: Dr Munns, as a Paediatric Endocrinologist at the Westmead Children’s Hospital, can you shed some light on the impact of vitamin D deficiency when left untreated?

Maternal vitamin D levels are associated with optimal foetal skeletal development. Given the baby starts to develop a skeleton by the second trimester, it is important to ensure the mother is vitamin D sufficient throughout the pregnancy in order to support proper bone formation and prevent serious birth issues or musculoskeletal conditions such as rickets. In utero, vitamin D levels may also play a role in maximising foetal immune function and provide a platform for childhood growth. As such, especially given the additional demands placed on the body during pregnancy, all pregnant women at risk of Vitamin D deficiency should take a Vitamin

Assoc. Prof. Munns: The old adage of prevention is better than cure definitely rings true for vitamin D deficiency. My interest in vitamin D stems from the babies we have seen present with rickets, which is the inadequate mineralisation or demineralisation of the skeleton and a direct outcome of vitamin D deficiency during pregnancy. Rickets has continued to emerge as one of Australia’s major paediatric health issues in recent years and can lead to growth retardation or short stature, fractures and deformities of the skull, chest and limbs including bowed legs and flared wrists. Severe vitamin D deficiency in an infant can lead to hypocalcaemia (or low blood calcium) and seizures. While this sounds extreme, it is preventable. In some cases, neonates or young children also present with broken limbs and very weak bones.

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In terms of treatment, vitamin D and calcium are used to stop the seizures and ultimately play a key role in helping to restore the child’s vitamin D levels to normal and allowing the bones to heal naturally. If a child presents with vitamin D deficiency, especially a neonate or infant, it’s usually because their mother was vitamin D deficient during pregnancy. For this reason we also measure the mother’s vitamin D levels, and once treated their next child should not have these same problems. All the anxiety and trauma can be easily prevented if expectant mothers, particularly those at risk, are given a vitamin D supplement during pregnancy.

Editor: What are some of the other conditions that have been associated with vitamin D deficiency pharmacists should be aware of during pregnancy, for both mother and baby? Assoc. Prof. Munns: In addition to rickets, vitamin D deficiency during pregnancy has been linked with a number of associated conditions including pre-eclampsia, gestational diabetes and first trimester bacterial vaginosis. Further study is required before vitamin D deficiency can be said to cause these complications of pregnancy.

TRAINING AND EDUCATION

“If a child presents with vitamin D deficiency, especially a neonate or infant, it’s usually because their mother was vitamin D deficient during pregnancy.” For the developing baby, in addition to rickets, vitamin D deficiency has been associated with lower birth weight, neonatal hypocalcaemia and prematurity.

Editor: Pharmacists are also aware of the role Omega-3 plays for an expectant mother and developing baby. Why is this so important? Assoc. Prof. Munns: Omega-3 DHA plays many important roles in the body and is a major structural and functional lipid of the brain and retina. Fatty acids are used in the construction of the lipid bilayer in brain cell membranes, and dietary intake is reflected in membrane levels. Not only does Omega-3 help increase blood and plasma levels in pregnant women, it is known to increase the DHA level in breast milk. For the developing baby, Omega-3 supports foetal growth and brain, visual and nerve development. The demand for DHA rises exponentially during the third trimester as the foetus’ brain rapidly expands during this period. The incorporation of DHA into growing neurons is a prerequisite for the formation of synapses within the nervous system and may help infant’s information processing, attention and problem solving skills.

Pregnant women are limited to eating only two serves of oily fish low in mercury per week. Supplementation may therefore be a suitable alternative to ensure required intake is met.

few weeks of pregnancy, so it is important to start taking folic acid at least one month prior to conception and continue for the first 12 weeks of pregnancy.

Editor: Further, the role of Folic Acid and Iodine is considered vital for mother and developing baby, with perhaps a little more discussion centring on the former.

Interestingly, iodine requirements in expectant mothers increase by nearly 50% during pregnancy. It is critical for normal brain and hearing development in the baby.

Assoc. Prof. Munns: Adequate folate levels at the time of pregnancy have been shown to decrease the incidence of neural tube defects by approximately 70%. Folic acid is needed for the synthesis of DNA and thus plays a role in normal cell division. In the developing foetus, the neural tube eventually becomes the baby’s brain and spinal cord. The neural tube closes in the first

Editor’s note – ITK invites Australian Community Pharmacists, who would like to learn more about the importance of Vitamin D and other essential nutrients during pregnancy, to visit the Pharmacy Guild Acadamy online. The CPD accredited training module is now available at www.guild.org.au/academy.

For orders and customer service Please call us on

www.ostelin.com.au

T: 1300 130 612

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

GUILDCARE

Patient Adherence Programs Building Sustainability in Pharmacy BY ROMA CECERE General Manager – Strategic Business Performance, GuildCare

One of the core roles of pharmacists is to prevent and resolve medication related problems. Having completed four years of education, pharmacists are often seen as being over-educated and under-utilised as a profession. Globally we see this trend changing where pharmacists are taking on more clinical roles, not just dealing with minor ailments, but delivering other health services, such as disease specific health checks, vaccinations, wellness programs, as well as assisting patients with their adherence to their prescribed medications, either through formalised government sponsored programs or privately sponsored programs. Volumes of studies examine factors impacting a patient’s adherence to a prescribed regimen, but this is a complex

issue where no single solution addresses all the factors. Pharmacists are well positioned to tackle the issue of adherence. They are the most accessible healthcare professionals; they are trusted; they see patients on average fourteen times a year and they have access to the patient’s dispense history. GuildLink provides a suite of patient adherence programs with varied interactions (including QR codes, SMS, links to videos, calls from GuildLink’s Pharmacist Support Centre) depending on the molecule and patient’s needs. However, the software

“Pharmacists are well positioned to tackle the issue of adherence. They are the most accessible healthcare professionals; they are trusted; they see patients on average fourteen times a year and they have access to the patient’s dispense history.”

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is simply the enabler; it assists pharmacists in identifying patients who are non-adherent or newly initiated to therapy, and also in recording of the service. What makes the difference is the pharmacist’s interaction with the patient. GuildLink’s analysis of the patient adherence programs shows that a pharmacist’s interaction with the patient can increase patient’s adherence to the medicine by 1.5–2 scripts per year. GuildLink is committed to pharmacy and our core focus is to enhance sustainability of pharmacy by providing software solutions necessary to build a business model whilst addressing patient adherence. The new reporting functionality will provide pharmacy with key insights into the number of patients qualifying for a patient adherence program along with the number of completed cases.

For more information on the GuildCare patient adherence programs or the new reporting functionality please visit www.guildcare.com.au.

Sore Eye Relief

Murine速 Sore Eyes. Relieves the irritation from sore, red eyes caused by eye strain, fatigue, minor allergy, swimming, smog and other irritants. Always read the label. Use only as directed. If symptoms persist, see your healthcare professional.

www.murine.com.au

Category Review

Eye Care in Pharmacy By Nate Hentschel

The increased use of computers and air-conditioning, coupled with allergy season, has led to dry or itchy eyes being just a selection of the complaints that are now common in pharmacies.

Pharmacist, B.Pharm.

The category of eye care in pharmacies is often overlooked, but it has quickly grown to include a number of products ranging from contact lens solutions through to drops, ointments and now sprays. Understanding the causes of eye symptoms, and recognising that many conditions have overlapping symptoms, will help you to recommend the appropriate products for patients in your pharmacy.

Dry Eyes The most common complaint, particularly in patients aged 40 years and over or in those who spend a lot of time on computers or phones, is dry eyes. People suffering

from dry eyes may experience a â&#x20AC;&#x2DC;grittyâ&#x20AC;&#x2122; sensation or complain of sore eyes and blurred vision. Often, patients will experience excessive tearing or watery eyes, as dry or irritated eyes tend to tear-up in an attempt to become moist again. Investigating the cause of the dry eyes will determine what drop is most appropriate. In most cases, dry eyes can be treated with a lubricating eye drop, such as Optive, GenTeal or Systane; it is up to patients to decide which brand works best for them. Generally, these drops are used four times daily. Chronic users should try preservativefree solutions to avoid irritating the eye,

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while those who only use solutions infrequently would be better served by a longer-lasting product, such as Systane Ultra.

Medications causing dry eyes Medications that cause dry eyes tend to be those which are dehydrating or have anticholinergic activity. These include diuretics, such as frusemide; tricyclic antidepressants, such as amitriptyline; some antihistamines; and anticholinergics, such as ipratropium. Numerous other medications also have the propensity to cause or worsen dry eyes.

Category Review

“Understanding the causes of eye symptoms, and recognising that many conditions have overlapping symptoms, will help you to recommend the appropriate products for patients in your pharmacy.”

Allergies

Counselling eye products

Usually accompanied by a runny nose or other allergic symptoms, allergic eyes often present as dry, red and itchy. Allergic eyes can be easily treated with an ocular antihistamine. Some oral antihistamines can cause dry eyes, which will only worsen the irritation, so if a patient has red or itchy eyes from allergies, an eye drop is preferred, such as Visine-A or Naphcon-A. These contain topical antihistamines in a lubricating base that will help to soothe the eye and to remove the itch and redness.

•• Always discard the product 28 days

Red eyes

Eye care is an often overlooked category in many pharmacies, and giving a little attention to the needs of the patients walking into your pharmacy can easily help to grow this range and can help your patients at the same time.

Caused by either dry or strained eyes, or other factors, such as allergies, tiredness, irritants or wind, red eyes usually feel sore and irritated. Depending on the exact symptoms and suspected cause, you may decide to provide a lubricating eye drop as discussed above.

300

sop

most eye drops do not need refrigeration.

•• Some patients may keep the eye drops cold to help feel when the drop hits the eye. •• If the patient is using multiple eye products, ensure the patient separates the times the products are used. •• Always ask the patient about contact lens use as some drops stain soft lenses.

10ml

can be used months after opening preservative-free phosphate-free compatible with all contact lenses

Revolutionary Device

after opening, unless otherwise stated.

•• Apart from some scheduled eye drops,

Red Eye Relief

Murine速 Clear Eyes. Clears away the redness and brightens eyes for up to 8 hours. Always read the label. Use only as directed. If symptoms persist, see your healthcare professional. 速Registered Trademark of Prestige Brands Inc. USA. Distributed by Care Pharmaceuticals Pty Ltd. ABN 30 009 200 604.

www.murine.com.au

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DOWN TO BUSINESS

Costs

Managing, not just cutting Peter Saccasan FACP FCA CTA Director of Pharmacy Services, RSM Bird Cameron Chartered Accountants

With the pressures on sales and margins, most owners reach for the slasher and take to the business overheads. Whilst there is nothing wrong with cutting out waste and moving overheads back to what is affordable, there can be a point where removing costs may prove harmful to your pharmacy. That is why costs should be managed, not just cut.

Relativity The starting point is understanding the relationship between costs and revenues. A business is, on the face of it, going to be $100 000 better off if wages are reduced from $400 000 to $300 000. But what if this means that customer service falls away to the point that sales drop off and the professional service offered can only be paid lip service? The pharmacy will suffer more. In this instance, what should be in focus is the relationship between wages and the outcome that flows from wages expense— the revenue. And in these times of falling sales dollars, the target revenue should be the trend in Gross Profit dollars and income from professional services. So owners should be managing wages expense relative to what the business is producing from those wages. My trends are showing that the best practice result is 30% or less and up to an upper range of 35%. Once again, the lowest ratio may not be the best. It may indicate under-servicing. The right ratio will depend on your business model and there will be curve of good and

bad outcomes. Below a certain point, your pharmacy will show signs of service and revenue stress. Above a certain point, and you won’t show returns commensurate with your investment in wages.

Flow on efficiencies The old adage is that sometimes you have to spend money to make money. This can certainly apply to the investment in dispensary automation in your pharmacy. The outlay for such an investment is not small. Yet the returns can be positive, making the large investment one that is worthwhile. By investing in a dispensary robot, you can: a. Increase pharmacist engagement time with the customer, thereby increasing companion sales and income from professional services and possibly increase medication adherence and script numbers b. Possibly return dispensary space to the retail floor for more yield c. Reduce the time taken to prepare scripts

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d. Reduce the time taken to manage dispensary stock e. Possibly create wages savings through a better mix of staff—although usually it is more beneficial to work on extra revenue gains through the better staff mix instead of just cutting staff numbers. These returns can represent a great return on the investment made in the following: a. Cost of the machine over a period of time b. Cost of the refit needed to put the machine in c. Machine maintenance costs d. Investment in extra retail stock for space returned to retail. Of course, what is needed is an implementation plan that will ensure the pharmacy takes the right steps to deliver on the returns set out above. This will include re-engineering the dispensary processes as well as the pharmacists’ approach to customers.

DOWN TO BUSINESS

“Most owners think of cost cutting as the only approach they can take to dealing with their overheads. The aim of the game should be to ensure that an adequate return is being achieved on the costs that are being committed.”

It will also need some KPIs to be measured to see how successful the move has been.

Pursuing Strategy A significant part of your pharmacy business plan will be how you go to market to attract customers—marketing, advertising, promotion etc. Should these costs be simply slashed in tough times? Once again, it’s about the relativity of these costs to the outcomes achieved. There is no point in having the best game in town but no-one knowing about it. So it is more about ensuring you chose carefully what you will spend and ensure it is specifically directed at an intended outcome. And measure the success, otherwise you won’t know if you made the right decision. With some overheads, you can only manage them in a limited way. The big one here is rent. Once the lease is signed, you could say it is set and forget. The important thing is to ensure you employ the right strategy for managing your rent. This article is not the place for further discussion on the topic, but suffice to say that step 1, for me, is to

ensure you allow more than enough time to achieve the best outcome you can when it comes to signing or renewing a lease. Many poor deals are done because the tenant has only one choice—to sign the lease that the landlord presents because of bad timing. Negotiating a good lease can make for the success of your pharmacy. Conversely, a bad lease will leave you with too big a hill to climb.

Just doing business smarter The biggest cost in pharmacy is the purchase of goods. Many owners do not pay enough attention to detail when it comes to finding the best deals and knowing what to ask and what a good price is. There are any number of brands and buying groups around that can help the business get to the best price. Certainly these groups can also sometimes not get it right. In these times of volume and compliance, it can pay to ensure that you are part of the right group for your pharmacy and that you get the best deals. Managing margin is of course a key aspect to getting the best outcome for your pharmacy.

Income tax is a real cost Finally, having done the hard work to make a good profit from business, your business structure may see more than its fair share making its way to the tax department. Owners should, from time to time, take a step back to ensure they are operating in the right structure that suits their business operations and overall group. This should incorporate the impact of tax on both business profits and capital gains. It should also take into account what tax you are paying before you can repay your bank debt. The less tax you pay to do this means the more cash you have available to pay off the bank. Most owners think of cost cutting as the only approach they can take to dealing with their overheads. The aim of the game should be to ensure that an adequate return is being achieved on the costs that are being committed. If the business strategy is a winner, then the right investment should be made to support it.

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MYSTERY SHOPPER

Mystery Shopper A symptom-based request HELEN STRACHAN Pharmacy Practice Officer The Pharmacy Guild of Australia, Queensland Branch.

A symptom-based request is when the ‘mystery shopper’ presents with a set of symptoms: ‘Hi, can I have something for red eyes?’

I’m sure that this sounds familiar to us all; and while it might just be a simple and common symptom, the request should be dealt with in the same manner as with any other scheduled medicine. It does become alarming to see products like Clear Eyes just handed over without any questions asked. Medicines are scheduled for a reason—they have the power to cause harm, especially if they are not used correctly. While customers feel confident at times about self-diagnosing the symptoms they are experiencing, it is our role and responsibility within the pharmacy to ask the appropriate questions to determine the condition they have and recommend an effective treatment. Staff should ensure that they refer to the pharmacist if ever unsure of a condition. For example, if the customer’s eyes just don’t look right or if the customer is taking any other medications, has any other medical conditions, is very young or is elderly. How would your staff go with this mysteryshopping scenario? ‘Hi, can I have something for red eyes?’ Pharmacies are assessed on whether or not they satisfy the following criteria as per the standard maintenance assessment (SMA) form that pharmacies receive a copy of on the day a mystery shop assessment is conducted:

•• Assessed who the request was for. •• Assessed whether the customer had used Clear Eyes before.

•• Assessed the actual symptoms of the red eyes.

•• Assessed how long the symptoms had been present.

•• Assessed whether the customer was

taking any other medications.

•• Assessed whether the customer had any other medical conditions.

•• Assessed if the customer had already tried any other treatment for the condition.

•• Provided at least one piece of verbal advice (e.g., discard the bottle 28 days after opening). •• Gave appropriate follow-on advice in case the customer’s symptoms did not improve (e.g., if the condition worsens or does not improve, see your doctor).

Mystery Shop outcome The outcome of a mystery shop will fall into one of three categories:

•• Excellent – 7 to 10 criteria met •• Satisfactory – 4 to 6 criteria met •• Unsatisfactory – 0 to 3 criteria met. Once the mystery shopper has conducted the assessment, a representative from the Guild returns to the pharmacy to discuss the outcome with the pharmacist in charge. A copy of the report is supplied to the pharmacist; however, the outcome is not final until the interaction is assessed by a pharmacist from the Australian College of Pharmacy. Following this process through the college, a final report is then sent to the pharmacy.

can be very beneficial to staff to assist in determining the difference between each of these conditions in order to recommend an effective treatment, or to refer the customer on to the pharmacist if required. Conjunctivitis is the inflammation of the conjunctiva (sclera—the white part of the eye). Conjunctivitis can be caused by allergy or by a viral or bacterial infection. Allergic conjunctivitis symptoms include itchy, red, watery eyes and are usually common in one eye only. Infective conjunctivitis is often associated with discharge. Eyestrain can occur if the customer is reading or using a computer without taking regular breaks, and eyestrain generally occurs in both eyes. Dry eye is regularly used to describe a symptom; however, dry eye syndrome is a specific condition that can be associated with ageing, some diseases and the use of some medications. General symptoms of dry eye syndrome include pain, irritation, blurred vision, itching and a feeling of having something in the eye.

Training tips for red eye conditions

The use of vasoconstrictors for longer than 5 days can lead to a rebound effect (redness); therefore, pharmacy staff should warn patients against the use of these for more than 5 days. Customers should also be advised to avoid triggers such as smoke or air-conditioning as these may worsen red, sore eyes.

The common eye conditions that are regularly seen in pharmacies may include conjunctivitis, eyestrain and dry eye. While a customer may feel that they have red eyes as a result of their eyes being dry, this may not necessarily be the case. Staff training on common eye conditions

As with many medications, overusing or not using the product correctly can be harmful. Pharmacy assistants should therefore refer the customer with ongoing symptoms, or those taking other medications or who have other health conditions, on to the pharmacist.

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MYSTERY SHOPPER

“How would your staff go with this mystery-shopping scenario? ‘Hi, can I have something for red eyes?’.”

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Gold Cross Product Reference Guide

The Gold Cross

First in Aid

Product Reference Guide

“Gold Cross is a brand name synonymous with trust, service and advice, and it is proudly endorsed by the Pharmacy Guild of Australia.”

A guide to making Gold Cross your first recommendation Dear Pharmacist, The ‘Gold Cross First in Aid Guide’ is proudly presented in this April/May edition of ITK as a daily reference tool for use in your pharmacy. Gold Cross is a brand name synonymous with trust, service and advice, and it is proudly endorsed by the Pharmacy Guild of Australia. An important element of this catalogue is that unlike many products today being descheduled and positioned in supermarkets by pharmaceutical companies, each of the products showcased in this catalogue are exclusive to you as an Australian community pharmacy. The catalogue has been designed as an ongoing reference tool. It outlines detailed product uses, features, technical information and fast facts for Gold Cross products in the key pharmacy categories of Cough and Cold, Skincare, Irritations, Cuts, Abrasions, Digestive Complaints and General Medicines. A comprehensive listing of the entire Gold Cross range, including PDE numbers available through leading wholesalers, are presented to complete this guide. Gold Cross is committed to growing the brand with a host of new initiatives designed to drive consumers into Australian pharmacies, supported by strong instore execution to educate consumers on the brand and to achieve the desired objective of product pull through your pharmacy. If you would like to know a little more about Gold Cross products, please contact your iNova Representative or iNova Customer Service on 1300 363 212. We are committed to expanding our range through the introduction of a pipeline of exciting new products in additional categories in 2014. Gold Cross is committed to ongoing training and enthusiastically recommends this catalogue as YOUR guide to first in aid for your customers. Yours in health,

Dusty Stringer General Manager – Sales and Marketing

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If you would like to know a little more about Gold Cross products, please contact your iNova Representative or iNova Customer Service on 1300 363 212.

Take your career further with Pharmacy Assistant Training. Whether you are a new or experienced pharmacy assistant we have a solution that will develop your career in pharmacy.

Contact your state branch of The Pharmacy Guild of Australia for more information: NSW & ACT: 02 9467 7130 or training@nsw.guild.org.au VIC: 03 9810 9988 or training@vic.guild.org.au QLD: 07 3831 3788 or admin.training@qldquild.org.au

TAS: 03 6220 2955 or tastraining@guild.org.au SA & NT: 08 8304 8388 or trainingsa@guild.org.au WA: 08 9429 4100 or training@wa.guild.org.au

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FABFOL® contains B group vitamins.

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proffesional review

There is no cure… but prevention is always better

Macular Degeneration

Macula with early degeneration

BY Pat Gerry Optometrist and Sports Specific Consultant at Eyeman www.eyeman.com.au

If something is degenerative it means it gets worse with time, or in the case of humans—it gets worse with age. For many Australians, the reality of this hits with the seventh decade of life.

After 60, the incidence of Cataracts, Glaucoma and Macular Degeneration all increase significantly. The first two of these conditions are more readily treatable (not necessarily curable) than the latter condition, Macular Degeneration. Whilst Glaucoma typically attacks vision from the periphery and Cataracts can affect any part of your vision, unfortunately the macula is the central part of our vision, and degeneration of the macula means loss of central vision.

Normal Macula

“Unfortunately the macula is the central part of our vision, and degeneration of the macula means loss of central vision.”

and maybe some well chosen genetics, the overall population is living longer, and with that invariably come age-related diseases despite doing all that is possible to prevent such conditions occurring. Macular Degeneration is such a condition and as a result has a very high incidence in the population over the age of 80.

The loss of central vision is debilitating, and for many the effects can be depressing. It may simply be the disturbance of reading, ending its enjoyment or it can be more severe, leading to complete loss of independence. Macular Degeneration though is one of those age-related diseases that some research has shown can benefit from over-the-counter intervention. It can’t be cured, but its impact on the loss of vision can sometimes be minimised.

From my experience and from what I see in my practice, many patients present to me who have identified Macula changes, however, this doesn’t mean they are degenerative and I believe this has led to much confusion. Identification of changes at the Macula leads to fear of Macular Degeneration and the patient undertaking a quest to not go blind. Whilst the chance of their vision deteriorating is significant, fewer people end up with a significant debilitating disease. I am by no means underplaying the significance of vision loss with Macular Degeneration, but rather highlighting the fact that many people do not end up with a debilitating loss of vision. The reasons for this are many and not necessarily well identified, but without doubt, the understanding of the impact of lifestyle, diet and dietary supplements is playing a role

As with all age-related conditions, typically prevention is a better option than trying to find the cure. It seems that due to a better understanding of healthy living,

Ongoing studies continue to look at the impact of failing vision on the public and the benefits of intervention, which includes the use of dietary supplements. The beneficial

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

anti-oxidants that have been identified include: Vitamin C, Vitamin E, Beta-carotene, Zinc, Zeaxanthin, Selenium, Lutein, Calcium, Thiamin, Folic acid, and Omega-3 essential fatty acids (including flaxseed oil). It should be noted though that many practitioners are wary of the possible adverse effects of Beta-carotene (especially in high concentrations), whilst intake of Selenium also needs to be monitored. We all need to also remember that factors such as medical history (and even family history), including current medications, need to be considered before any supplements are advised or consumed. These points need to be discussed between the patient and their GP and/or pharmacist. Finally, there is a smaller group of patients that present a bigger concern in my practice. These are the patients who have age-related eye diseases such as Macular Degeneration at a premature age (i.e. in their 50s rather than late 60s or 70s). Quite often they bring with them general medical problems that are often the result of lifestyle choices. Choices which at the time didn’t seem to matter, and now they ask me what they can do. The advice is probably not that different to what their GPs and Pharmacists tell them—you need to stop smoking; modify your diet; wear protective eyewear or headwear, and even do some exercise.

HYLO-FRESH and HYLO-FORTE Eye Drops

TRAINING AND EDUCATION

Product training

Dry eye is a disease that afflicts many Australians, and with multifactorial causes that range from the physiological to the environmental, as well as being a function of age, it is a condition that is likely to become even more prevalent in our society. However with HYLO®FRESH and HYLO-FORTE® preservative-free eye drops there is a revolutionary device that provides intensive and long-lasting lubrication for dry eyes in a patented multi-dose application system.

What is the COMOD® application system, and why is it different?

What should HYLO®-FRESH and HYLO-FORTE® be used for? HYLO®-FRESH (sodium hyaluronate 0.1% w/v, 10mL) is for the treatment of dry eyes of moderate to medium severity, while HYLOFORTE® (sodium hyaluronate 0.2% w/v, 10mL) has a higher concentration of sodium hyaluronate and higher viscosity for the intensive treatment of severe and chronic dry eye or for post-operative treatment.

Who should use preservativefree eye drops? Preservative-free ophthalmic medicines are recommended for patients undergoing long-term treatment, those with ocular surface diseases and those who have sensitivity to preservatives. They are especially recommended for patients with allergies, glaucoma and dry eye.

What do I need to know about Sodium Hyaluronate? Sodium hyaluronate (hyaluronic acid) is the key ingredient in both products. The use of high quality, long chain sodium hyaluronate in both HYLO®-FRESH and HYLO-FORTE® results in high viscosity drops that stay longer on the ocular surface for a more intensive, long-lasting moistening effect without vision impairment. In essence, sodium hyaluronate provides the effect of a gel with the comfort of a drop.

Preservative-free eye drops are a more tolerable option for patients than those containing preservatives, but the majority of preservativefree eye drops are available as packs of single dose units that should be discarded after exposure to the air in order to prevent the possibility of contamination. HYLO®-FRESH and HYLO-FORTE® are different, as they both utilise the ingenious COMOD® multi-dose application system. This airless application system prevents contamination in the bottle and provides for the precise delivery of multiple sterile doses of preservative-free medication, ensuring that HYLO®-FRESH and HYLO-FORTE® can be used for 6 months after opening. These products therefore combine the convenience of a bottle with the superior tolerability of preservativefree medication, delivered through a patented multi-dose application system that keeps the medicine 100% sterile and ensures a consistent and precise dosage each time it is used.

They seem expensive – why should my customers consider buying a more expensive product? With a minimum of 150 treatments (both eyes) per 10mL bottle, HYLO®-FRESH and HYLO-FORTE® provide at least 5 times more treatments per pack* compared to the largest packs of single-use preservative-free eye drops currently available in Australia. And although the recommended OTC retail price of $34.95 may seem expensive compared to single-use preservative free eye drops, the cost per treatment (both eyes) with the multi-dose HYLO®-FRESH and HYLO-FORTE®

eye drops is on average between 37-60% less** than the most well-known single-use preservative-free eye drops.

HYLO®-FRESH and HYLO-FORTE® are also phosphate-free – why is this important? Because HYLO®-FRESH and HYLO-FORTE® eye drops are citrate buffered, and therefore phosphate-free, they prevent the damaging corneal calcification that results from permanent deposits of calcium phosphate found in phosphate-buffered eye drops.

Can you use HYLO®-FRESH and HYLO-FORTE® eye drops with contact lenses? Yes, both HYLO®-FRESH and HYLO-FORTE® are compatible with all types of contact lenses.

Are these products also available on the PBS? Both HYLO®-FRESH and HYLO-FORTE® eye drops are available on the PBS, listed on both the General and Optometrical schedules for the treatment of dry eye.

For more information about HYLO®-FRESH and HYLO-FORTE® you can contact your AFT representative or call the AFT Pharmaceuticals Sydney office on (02) 9420 0420.

* Based on unit dose preservative-free eye drops available in Pharmacy as at March 2014. 1 treatment = 1 unit dose vial used to treat both eyes. ** Average retail pricing from pharmacy price survey conducted 13th August 2013. Data on file. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

Professional review

Don’t be in the dark about

Macular Degeneration

BROUGHT TO YOU BY

Don’t be in the dark about macular degeneration – the eye disease that affects one in every seven Australians over the age of 50. That’s the message being communicated by Macular Disease Foundation Australia this year in Macular Degeneration Awareness Week (May 25–31).

Over 1.15 million people over 50 in Australia show some evidence of this disease and this number will increase to over 1.7 million by 2030 (in the absence of effective prevention and treatment measures), creating an even greater burden on Australia’s health, disability and aged care systems.*

“Customers who report any sudden changes to their vision should visit their optometrist or ophthalmologist as a matter of urgency.”

Macular degeneration causes progressive macular damage, resulting in loss of central vision, but the peripheral vision is not affected. Macular Disease Foundation Australia Chief Executive Officer, Julie Heraghty, warns that you can have the very early signs without even knowing. As macular degeneration occurs at the back of the eye, an eye test is the only way to identify the disease in its earliest stages. An optometrist can easily check for drusen—small yellow deposits or waste products at the back of the eye—which indicate the early signs of the disease.

Wet and dry macular degeneration Wet and dry are the two types of macular degeneration, and early detection of both is critical to saving sight. There is now effective treatment for the wet form of the disease; however, it is essential to act immediately upon noticing any changes in vision. Delaying treatment increases the likelihood of irreversible vision loss, and for this reason changes in vision should be treated as a medical emergency. While there is currently no treatment for dry macular degeneration, it is critical to monitor disease progress. Adopting certain diet and lifestyle changes can help to slow down the progression of the disease. It is critical for people to monitor for any changes in vision with an Amsler grid because dry macular degeneration can turn to the wet form very quickly. The Amsler grid does not replace an eye test, but should be used between appointments to ensure any changes are picked up immediately. “Customers who report any sudden changes to their vision should visit their optometrist or ophthalmologist as a matter of urgency,” advises Julie. Those who smoke are three to four times more likely to develop macular degeneration, and may develop the disease five to ten years earlier than non-smokers. Julie goes on to say, “The simple fact is, smoking causes blindness and it is critical that people quit to save their sight.” “Maintaining a diet that is rich in green leafy vegetables and eating fish high in omega 3 fatty acids—such as salmon and mackerel— can reduce the risk of developing macular degeneration, along with a low glycemic index (GI) diet.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

Professional review

AREDS2 supplements can be beneficial People who have been diagnosed with agerelated macular degeneration should consider taking a supplement based on the AREDS (age-related Eye Disease Studies) formula. The AREDS research are the only studies for which there is good, long-term evidence for the benefits of high dose nutrients for people diagnosed with age-related macular degeneration. The original AREDS study showed that a supplement based on a specific formula of zinc and antioxidant slowed the progression of age-related macular degeneration for people in the intermediate stage in one or both eyes, or in the late stage in one eye. The AREDS formula reduced the risk of progression of the disease by 20–25% and delayed vision loss. The AREDS study showed that the formula had no effect on those who did not have agerelated macular degeneration, or only very early signs (a few small drusen), or for those with advanced disease in both eyes. The AREDS study shows that taking the AREDS formula may reduce the risk of progression; it does not stop or reverse damage caused by the disease and is not a cure. In May 2013, the AREDS researchers announced the results of their follow-up study, AREDS2. Their recommendation was the continued use of the original AREDS formulation, but with beta-carotene removed, to be replaced by lutein/zeaxanthin. The AREDS2 formula daily dose comprises:

•• •• •• •• •• ••

Zinc (as zinc oxide) – 80 mg Vitamin C – 500 mg Vitamin E – 400 IU Copper (as copper oxide) – 2 mg Lutein – 10 mg Zeaxanthin – 2 mg

Due to current regulations, the labels on many products will say take 1 tablet per day or as professionally prescribed. However, typically more than 1 tablet is required to get the AREDS2 dose. Pharmacists should be aware of the importance of correct formulation and dosage when recommending supplements to customers.

What role does the pharmacist play? Pharmacists are in a unique position in the community to get to know their customers and discuss eye health issues. Changes in vision should never be dismissed as “just getting older” and pharmacists should reinforce that it is essential for customers experiencing changes in vision to visit an optometrist or ophthalmologist immediately.

Symptoms (known as the four Ds) can include: Difficulty with detailed or fine vision Distortion, where straight lines appear wavy or bent Dark patches or empty spaces appearing in central vision Distinguishing faces becomes a problem.

The need for increased illumination, sensitivity to glare, decreased night vision and poor colour sensitivity may also indicate that there is something wrong.

•• Quitting smoking – those that

Pharmacists have the skills and expertise to educate their customers and provide advice on healthy living. You can reinforce the messages of eye health professionals by discussing the following key points with your customers:

•• Healthy diet and lifestyle –

•• Monitoring for changes in vision – the importance of regular eye tests with an optometrist or ophthalmologist and daily self-monitoring for changes in vision using an Amsler grid.

•• Supplements – the role supplements can play in disease prevention and in slowing progression for those who have been diagnosed.

smoke have 3 to 4 times the risk of macular degeneration and should be encouraged to quit. the importance of a healthy, well-balanced diet including fish two to three times a week, dark green leafy vegetables and fresh fruit daily, a handful of nuts a week, choosing a low glycaemic index (GI) carbohydrate, and limiting the intake of fats and oils. Also important is regular exercise and maintaining a healthy weight.

•• Sun protection for eyes – ensuring eyes are given adequate protection from sunlight exposure.

What resources are available? As part of Macular Degeneration Awareness Week, the Foundation sends every pharmacy across Australia an “Awareness Kit”. These kits include key information on macular degeneration, along with supporting promotional material for Macular Degeneration Awareness Week. The information will include the Foundation’s Nutrition and Supplements for Macular Degeneration fact sheet, a Macular Degeneration key facts brochure, Foundation contact card, Amsler grid, campaign poster, and an order form for FREE resources. In addition, pharmacists can join the Macular Disease Foundation Australia Professional Friend program to demonstrate their ongoing support of the Foundation and commitment to being at the forefront of client support services. To find out more about the program, contact the Foundation. Macular Disease Foundation Australia provides FREE resources on macular degeneration to practitioners and the general public throughout the year. The Foundation also offers a Helpline for support and advice.

Don’t be in the dark about Mac ular Degenerat ion

Macular Degenera tion is th in Austra e lia and af leading cause of bli fects cent If you’re ov ral vision ndness er 50

• Have an eye is checked test and make sure your macul a • Never ign ore any cha nges in vis • Eat an “ey ion e friendly” diet and ma healthy life style intain a

For a fre e inform ation kit and sup port con Macular tact Dis Foundatio ease n Australia

1800 111 709

www.mdfo undation.co m.au

ISL-249-PB

(MD A2 Poster

2014).indd

Customers can be advised to telephone 1800 111 709.

For further information on macular degeneration visit www.mdfoundation.com.au or visit www.sightforseniors.com.au to view prevalence data for macular degeneration in your state or federal electorate.

* Eyes on the future – A clear outlook on age-related macular degeneration. Report by Deloitte Access Economics & Macular Degeneration Foundation, 2011. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

13/03/14

11:23 AM

TRAINING AND EDUCATION

Clear red eyes and brighten When you work too hard or play too hard, the surface of your eyes can sometimes become red and irritated. Lots of things can cause red and bloodshot eyes, from lack of sleep to smoky environments and swimming in chlorinated pools. Red or bloodshot eyes are caused by widening or dilation of blood vessels in the white part of the eye. The blood vessels look prominent and give the white of the eye a pink/red appearance. The solution: Murine® Clear Eyes clears away the redness from the night before and brightens the eyes for up to 8 hours. The key active ingredient in Murine® Clear Eyes is Naphazoline Hydrochloride, which is a decongestant and vasoconstrictor that helps reduce unsightly blood vessels to remove the redness and brighten eyes.

Soothe and moisten dry eyes We’re all susceptible to experiencing dry and overworked eyes from our modern lifestyle. Working at computers for extended periods, long-distance travel and air-conditioned environments are all culprits. Contact lens wearers and older people (particularly women due to hormonal changes such as menopause) are also prone to experiencing dry eyes more frequently. Each time the eye blinks the eyelid spreads tears across the surface of the eye to form a film. The film acts to reduce the evaporation of moisture from the eye, helping it stay hydrated. Dry eyes can occur when we either don’t produce enough tears or when a gap in the protective film allows moisture to be lost. The solution: Murine® Revital Eyes soothes and moistens dry eyes. Murine® Revital Eyes is a gently buffered solution specially formulated to closely match the natural fluid of the eye. The ‘artificial tear formula’ contains many of the major ingredients found in natural tears. It is ideal for lubricating eyes that feel dried out and irritated.

What a relief

TRAINING AND EDUCATION

Relieve sore, irritated and strained eyes Many factors in our modern lifestyle and environment can irritate the eyes, making them feel sore and uncomfortable. Eyes can become sore and irritated for many reasons. Common triggers include too much time on the computer, driving or reading for long periods, air-conditioning and environmental triggers such as dust, pollen and air pollution. People suffering from a cold or allergy can also experience irritated, sore eyes. As we get older our eyes become more sensitive to irritants. The eye’s natural protective and repairing processes start to slow down. The solution: Murine® Sore Eyes relieves sore, irritated and strained eyes. Murine® Sore Eyes is a specially formulated ocular decongestant with Tetrahydrozoline to help relieve burning, irritated and strained eyes.

Clear, Relieve and Soothe with Murine Eye Health Tips • D rink plenty of water to keep your whole body including your eyes hydrated • T ake regular breaks from your computer screen – look away from the screen at least every 5 minutes and focus on something further away • A void glare from computers by reducing screen brightness or using a screen shield. • Try and get plenty of sleep by avoiding repeated late nights • When driving long distances take a break every 2 hours • W ear goggles when swimming to stop chlorine irritating the eyes • A lways wear safety glasses when doing DIY or gardening to protect eyes from injury or dust particles

For more information on Murine Eye Drops, please contact your Care Pharmaceuticals Representative. Call 1800 788 870 or visit www.murine.com.au Always read the label. Use only as directed. If symptoms persist, see your healthcare professional. ®Registered trademark of Prestige Brands Inc, USA. Distributed by Care Pharmaceuticals Pty Ltd. ABN 30 009 200 604

down to business

Frontline Health finding candidates without ads

How to find candidates without placing a job ad Where is your next great hire going to come from? Finding the right employee for your healthcare organisation can be challenging, so if you want to make sure you don’t miss out on the best candidates, it’s a good idea to look in a few different places. Many recruiters rely solely on posting job ads online, and although this can be a highly effective way to find new employees, there are other places that are also worth a look.

Networking events and industry gatherings It’s well worth taking the time to get the contact details of people you meet at networking events who you feel might be a good fit for your organisation. Even if they aren’t currently looking for work, and you aren’t looking to hire then and there, having a bank of potentials to draw from can take some of the hassle out of finding the right person when you need them. Maintaining your professional network is good not only for your own career development, but also for your staffing needs as someone you know might know the perfect person.

Word of mouth This can be a highly effective way to find potential candidates for your organisation. Spread the word about available positions as and when they come up and you might find that someone you know knows the perfect person for the job. Word of mouth recruitment comes with the benefit of already having a personal recommendation, and you can also reach people who might not be actively looking for a new role, but could be thinking about a change.

Recruitment agencies Healthcare recruitment specialists will know of good people who might be looking for employment and who could be the right fit for your organisation. These specialists often have extensive contacts in the industry and usually have a number of pre-screened applicants on their books. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

Social media Social media is one way that tech-savvy businesses can get ahead of the competition when it comes to successful recruitment. Social media recruitment is becoming increasingly popular across all industries. Social media is low cost and, through social sharing and referrals, can give your business exposure to a wide audience. Social media reaches people who may not be actively searching for a new job as well as proactive job seekers. Pre-screening and contacting potential candidates are made more straightforward with social media. You can check over potential candidates’ profiles and screen out anyone who looks unsuitable or as if they wouldn’t be a good fit for your organisation. With social media you can therefore get more of an idea of the personality of each of your potential candidates, which can be invaluable in a people-based industry where strong interpersonal skills are highly desirable. To use social media effectively it is a good idea to have a strong brand presence. This can help you attract interest from prospective candidates even when you aren’t currently looking and can give you a base of people to draw from when you are actively recruiting. Make sure you choose the best platform for your target candidates. LinkedIn is the main social media platform that recruiters use, but there may be industryspecific blogs or websites that could also yield good results. It’s wise to try a few different options when you are looking for candidates. This can help you broaden your reach and give you a wider pool of people to choose from. By using every method available to you, you can increase your chances of finding the best possible candidates for your next vacancy.

For more information, please contact your local Frontline Health consultant at www.frontlinehealth.com.au

Dry Eye Relief

Murine速 Revital Eyes. Soothes and moistens your overworked, dry eyes. Always read the label. Use only as directed. If symptoms persist, see your healthcare professional.

www.murine.com.au

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RETAIL FOCUS

DISPENSARY

FRONT OF SHOP

Getting the Engine Room Working for Your Business PullOut Shelves for:

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» Gondola Drawer “Pharmacists are wasted standing behind the » Flat Shelves dispensary dispensing medications. They are far more beneficial being out the front, on the sales floor, being the first point of contact for a customer.”

Blister Pack Racks

I have run exercises in the past where We have all felt the effects of the ongoing a comparison of sales was undertaken PBS reforms – some more than others – between when it comes to our dispensaries. From the ™ a Pharmacy Assistant and a Pharmacist. The results saw the Pharmacist articles I have read recently, there is no light an average sale 2.5 times that of the at the end of the tunnel until weQUALITY reach 2016, SHELVINGhad AT AFFORDABLE PRICES Pharmacy Assistant. Why is this? You have which is still a long way off. This means you far more knowledge of interactions, and the really can’t ride out the storm without suffering customer trusts every word you tell them, major impacts on your profitability. so therefore they are more inclined to I’m sorry to say, but if you haven’t already purchase based on your recommendation. been investing in your retail strategy to drive

FLOWSELL

sales, you are well and truly behind the eight ball. It isn’t the end of the world though, as you can start now. In a past column I mentioned that, as an industry, we needed to have a business split of 60/40, where 40% of your business is retail within 12 months. That time is now!

Adopting this method, you will be able to receive scripts (personally) and check them as you take them back out to the customers. As business owners, you are better off to use the skills of a Dispense Tech to fill the prescriptions. They are more cost-effective and can be more productive for the business.

So where to start? The quickest place is to look at the engine room of your business—the dispensary. While margins are being stripped out through the reforms, you still have one thing guaranteed, and that is foot traffic. What you do with this foot traffic will determine just how quickly you will grow your business.

Obviously to implement this strategy, you will need to have the correct amount of resources. This may mean you need to recruit, however, I would suggest you really consider the financial impacts of this before you go ahead. You would need to be confident that you are going to make a return on this investment. Now more than ever, we need to be very mindful of spending additional monies and controlling our expenses.

To be able to convert your dispensary traffic into retail sales you will need to, if you haven’t already, change your mindset on what the role of a Pharmacist is. It is my opinion that Pharmacists are wasted standing behind the dispensary dispensing medications. They are far more beneficial being out the front, on the sales floor, being the first point of contact for a customer.

If the above strategy isn’t going to work for you, then look at ways of getting the information required to achieve the add-on sale. We all know that a probiotic is a good add-on to an antibiotic and CoQ10 is a good option for a statin and so on; however, there are potentially thousands of other options

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

Blister Pack Work Stations BY »SIMON HAMBRECHT Director of Pharmacy Essentials

available to you for all the other medications you dispense. Has anyone ever thought to sell sanitary pads with any anti-fungal treatments? So how do you get this information to the team and then onto the customer? There was once a Pharmacist I used to deal with who made great use of post-it notes. Once he had labelled the medication, he would write some options for the add-on sale on a post-it note and send it out with a Pharmacy Assistant to suggest those items to the customer. On a whole, this was very successful.

WWW.FLOWSELLPHAR

There any many other ways you can achieve this. I suggest you sit down and discuss it with your Team at your next Team Meeting. I’m sure they will have ideas on how to achieve this in your business. My parting words of advice to you all— if you want to achieve more add-on sales in your retail area and change the split of your business then leverage your profession as a Pharmacist and have your Team use the following words when attempting an add-on sale with a dispensary item: “The Pharmacist has recommended you use (insert product name/type) in conjunction with your medication for a better result.”

Quality dispensaries that do not break the bank MORE CHOICE MORE AFFORDABLE

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PullOut Shelves for:

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» Gondola Wall Units » Double Sided Gondolas » Wall Stripping » Cabinet Shells » Rear Load Cabinets » Cupboards » Compactus Systems » Drawers » Under Bench Drawers » Gondola Drawer » Flat Shelves

» » » » » » » » » »

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DISPENSARY

FRONT OF SHOP

PullOut Shelves for:

Fixtures Including:

Gondola Wall Units

Wall Units

Double Sided Gondolas

Island Gondolas

Wall Stripping

Gravity Shelving

Cabinet Shells

Flat Shelving

Cupboards

Product Dividers

Compactus Systems

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» » » » »

Discover how FlowSell ergonomic dispensaries can save you money. Drawers

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Visit our website for design options WWW.FLOWSELLPHARMACYSOLUTIONS.COM.AU GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

ADVERTORIAL

Clear Eyes by Murine® Wipes Clear Eyes by Murine® Wipes are uniquely textured hypoallergenic wipes for effective, gentle cleaning of the eyelids and lashes.

Companion sales opportunity with every eye care product sold Free of alcohol, fragrances, preservatives and enriched with chamomile extract.

Clear Eyes by Murine® Wipes can be used directly from the sachet or as a hot or cold compress.

Ophthalmolgist and Dermatologist tested and recommended.

Clear Eyes by Murine® Wipes can be used daily to remove ocular secretions, scales, crusted matter and makeup.

They have been tested and recommended for use on sensitive skin, especially the delicate surface around the eyes.

The wipes are carefully pH-balanced to match the natural pH of human tears, making them ideal for contact lens wearers.

For more information or to request samples, contact your Care Pharmaceuticals representative Call 1800 788 870 or visit www.murine.com.au Always read the label. Use only as directed. If symptoms persist, see your healthcare professional. ® Registered trademark of Care Pharmaceuticals Pty Ltd. ABN 30 009 200 604.

ADVERTORIAL

A Little Bit of Relief Natural pain relief in a cooling gel A Little Bit of Relief is a 100% Australian owned & made pain relief gel, formulated from natural active ingredients for the temporary relief of:

“A Little Bit of Relief uses natural active ingredients, including eucalyptus and peppermint oils.”

•• •• •• •• •• ••

Arthritic Pain Rheumatic Pain Muscular Aches Backache Cramps & Spasms Sports Injuries

TV ADVERTISING FEATURING DAWN FRASER A Little Bit of Relief is endorsed by Dawn Fraser AO,MBE Olympic Gold Medallist. Dawn Fraser appears on the current A Little Bit of Relief TV advertisement.

People all over Australia are turning to A Little Bit of Relief.

NATURALLY EFFECTIVE A Little Bit of Relief uses natural active ingredients, including eucalyptus and peppermint oils. These act as effective analgesics and anti-inflammatories to temporarily ease pain and reduce swelling, without the unwanted side effects of many other medications.

Visit alittlebitofrelief.com for more information. For pharmacy orders, contact Clear Sales Australia on 1800 640 043 or order direct from Symbion, Sigma or API.

MORE RELIEF, LESS HASSLE PRODUCTS A Little Bit of Relief is a cooling, pain relief gel that comes in 2 convenient dispensers.

A Little Bit of Relief Tube 100g This handy tube is perfect for carrying in a bag or when travelling. Great for active people on the go.

A Little Bit of Relief is an easy to apply gel. Apply liberally to the affected area. Use 3 to 4 times daily. Rub gently in circular motion until completely absorbed into skin. Re-apply as often as required. A Little Bit of Relief has been formulated to be suitable for long term use, such as for the management of chronic pain.

AUSTRALIAN OWNED A Little Bit of Relief is 100% Australian owned, and proudly Australian made.

A Little Bit of Relief Pump 150ml An easy, quick dispenser for the home or at work. Perfect for keeping on a desk or in a cupboard.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

down to business

Patient-centred care:

the way forward for community pharmacy, but where do we start?

BY vanessa lontos Community Pharmacist and Consultant

Australian pharmacists are in the process of shifting towards an approach to service delivery that is more patient centred. This movement has progressively built over time for a variety of reasons—from reduced dispensing revenue through to the rise of the discount category, and even to an inherent knowledge that this way of practice is just ‘the right thing to do’.

However, the concept of patient-centred care remains ambiguous and somewhat subjective1; it remains ‘nice to have’ instead of being the ‘new kind of normal’. There are more resources, guidelines and templates to assist us in this change process; however, a total shift to this model is challenging for many. How do we invest, restructure and build towards this patient-centric ideal and keep doing all that we have to keep doing? The answer is complex but begins with a simple and important distinction: a patientcentred model can only build from a patientcentred culture, and that begins with us— the people working in the pharmacy.

“A patient-centred model can only build from a patient-centred culture, and that begins with us—the people working in the pharmacy.”

References 1 ‘A systematic review of patient-centred care: implications for community pharmacy’, viewed at www.5cpa.com.au. 2 D Quilty, ‘Putting patients first’, Forefront, vol. 3, no. 42, 2013, viewed at www.guild.org.au. 3 ibid. 4 S Frampton et al., Patient-centred care: improvement guide, Planetree (with Picker Institute), Derby, CT, 2008. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

Patient-centred care involves placing patients at the centre of their own care, or, more simply, treating patients how they want to be treated. It takes into account the perspective of patients—their goals, individual needs and values. In broad terms, it involves communicating with our patients to form a partnership to assist them in the quality use of their medicines while taking into account their lifestyle and wellbeing. A Griffith University study published in the International Journal of Pharmacy Practice found that a patient-centred approach was an important factor for patients with chronic conditions in deciding which pharmacy or pharmacies

down to business

Vanessa Lontos is a community pharmacist, former pharmacy owner and mum. She now runs a consulting practice assisting pharmacies to build patient-centred care ‘one person and one pharmacy at a time.’

they would frequent.2 The study found that from the perspective of the patient a pharmacy focused on patient-centred care displayed attributes such as: Individual care where pharmacy staff ensure a patient’s individual needs are met with a focus on continuity of care and explaining ‘why’, along with tailored medication information.

•• Empowering care where pharmacy staff are supportive and approachable and encourage patients to ask questions and seek advice.

•• Holistic care where pharmacy staff are genuinely concerned about the patient’s overall wellbeing and are sufficiently knowledgeable to assist with wider issues. •• Respectful care where pharmacy staff accept the patient’s individual traits and their knowledge of their own conditions, and are non-judgemental.3 A patient-centred culture is definitely not built overnight, but requires a long-term focus and a willingness to challenge ‘the way we’ve always done it’. It also requires an acknowledgement that reading a guideline, conducting training and putting an action plan into a folder will not most effectively contribute to this change—it definitely didn’t work in my pharmacy! But what did work was a shift in focus from a service that we can provide to an experience that we can create. A patient-centred culture requires an exploration into the commitment, capacity and connection that you have with every patient and that you have with each other. Let’s explore this a little further.

•• Commitment is defined as being dedicated to a cause, an engagement or an obligation that restricts certain actions or freedoms; namely, doing something even when you want to do something else. Exploring your culture and moving towards a more patient-centred approach comes with a natural ebb and flow of momentum.4 Rather than abandoning efforts when times get tough (and they’re always tough!) explore these challenges as opportunities for feedback on how you can do it better or differently. Celebrate the great days too—the days when you get a phone call about how kind and compassionate ‘the new girl was’ or ‘how helpful that young pharmacist was at explaining in detail even though there were lots of people standing in the shop’. William Osler (physician 1849–1919) said it well: ‘It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.’ This takes commitment.

•• Capacity—we are all busy. Ensuring that, as a team, you are supporting one another to build this culture is critical. The true test of a pharmacy focused on having the patient’s experience at the centre of everything it does is its sustainability and ability to endure during the really busy days. Times when you are short-staffed, the claim needs to be submitted, patients are demanding and you have a new staff member that needs induction, are change-defining days. A bucket of sand that is full cannot take on more, not even one grain. What do you as an individual, and as a team, need to stop doing to allow every patient’s experience to be great? A patient-centred culture isn’t built by ‘fitting it in’ when you aren’t busy—it is there all of the time. What do you need to remove from your buckets?

•• Connection—creating a feeling for someone that you are on their team takes time, consistency and practice! Connecting with our patients involves many things, but starting with a simple big, open smile can build rapport so quickly and achieve so much. Moving to standing beside them as opposed to behind a counter can communicate volumes. Asking them specific openended questions not only about their specific needs but also about how their work or family is, and really being present to them and not getting distracted, can create the foundation for a long relationship. The health journey is different for each individual that walks into the pharmacy, so take a bifocal perspective— acknowledge their immediate needs but see the big picture too—each individual is a person who has a story. Connect to that story.

In an industry as complex as the health industry where the incredible demands on healthcare providers are growing by the day, taking time to explore anything can feel too hard and like a huge task. To create a ‘new kind of normal’ try to begin by focusing on ‘the power of one’: one patient, one interaction, one minute, one day at a time—do just one thing. Who knows, it might just make the difference to someone’s day and begin to change their experience and health journey forever. It was Mother Teresa who said, ‘If I look at the masses I will never act; if I look at the one, I will.’ GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

PRODUCT SPOTLIGHT

Little Coughs®

MAXIGESIC®

FAB IRON Liquid Iron

The Little Coughs formula has been produced in Germany for over 30 years, providing soothing relief for coughs and chesty congestion for many little patients all around the world.

MAXIGESIC (Paracetamol 500g and Ibuprofen 150mg) is a world-first specific combination analgesic now available in Australia as a Pharmacist-Only (S3) Medicine.

FAB IRON Liquid Iron is a gentle, easy to absorb organic liquid iron with a natural fruity flavour to help restore energy and vitality and overall health. Available in a 250mL bottle that’s suitable for the whole family or convenient single dose sachets for people on the go.

The Little Coughs® ivy leaf formula is preservative free and does not contain sugar, artificial colours and flavours. Suitable for children under 6 years1.

Available in packs of 10, 16 and 30 tablets, MAXIGESIC® provides double-action relief from a wide range of pain and reduces fever. For more information contact AFT Pharmaceuticals on (02) 9420 0420. >> www.aftpharm.com

Consult a healthcare professional before using in children under 2 years. Always read the label. Use only as directed. If symptoms persist, see your healthcare professional. >> www.littlecoughs.com.au

Four core nutrients for healthy baby development Ostelin Pregnancy Essentials is new specialised pregnancy formula developed for healthy pregnant women to provide nutritional supplements that are not easily obtained in the “typical Australian” diet during pregnancy. It contains high strength Vitamin D for baby bone development, plus Folic Acid, Iodine and Omega-3 DHA.

Always read the label. Use only as directed. Vitamin supplements should not replace a balanced diet. >> www.ostelin.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

RRP $18.95 (250mL bottle) or $18.95 (20x 10mL sachets) >> www.fabhealth.com.au

PRODUCT SPOTLIGHT

Macu-Vision® Plus (60 Tablets)

Blackmores Lyprinol® Double

Ethical Nutrients Mega Magnesium

Blackmores Macu-Vision® Plus is a vitamin, mineral and antioxidant eyes formula that may help preserve overall eye health.

Blackmores Lyprinol® Double is a special anti-inflammatory supplement for the temporary relief of osteoarthritic pain. It contains double the amount of Marine PCS-524 Oil extract (Green lipped mussel oil) than the original Lyprinol® 50 mg capsule, so you can take less capsules.

Ethical Nutrients Mega Magnesium can help restore your magnesium levels, with the highly absorbable form of magnesium, Meta Mag®. Mega Magnesium may be of benefit during times of stress, and to relieve muscular aches, pains cramps and spasms. Available in tablets and a delicious Raspberry flavoured powder.

Lutein and zeaxanthin have been added to the original Macu-Vision® formula providing nutrients important to the macular region of the eye. Vitamin supplements should not replace a balanced diet. Always read label. Use only as directed.

If symptoms persist, see your healthcare professional. Always read the label. Use only as directed. >> www.blackmores.com.au

>> www.blackmores.com.au

Always read the label. Use only as directed. If symptoms persist consult your healthcare professional. CHC53006 – 07/13 >> www.ethicalnutrients.com.au

Co-Senna – effective relief from constipation Constipation is a common problem and affects most people at some time in their lives. Co-Senna delivers effective relief of constipation with dual action. Co-Senna tablets contain both a stool softener (docusate sodium) and a stimulant laxative (senna) for gentle, overnight relief of constipation. Each tablet of Co-Senna contains docusate sodium 50mg & total sennosides 8mg. Co-Senna is now available in bottles of 30’s (RRP $ 4.72) & 90’s (RRP $ 7.86) so recommend Co-Senna to your customers. Co-Senna is RPBS listed. Contact your Clear Sales representative on 1800 640 043 for special deals. >> www.petrus.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

WHAT’s NEW & company news

Socceroo star Tim Cahill partners with Cenovis Cenovis, the official vitamin of the Socceroos, has announced a new partnership with Socceroo star Tim Cahill. Luke Fitzgerald, Director of Sanofi Consumer Healthcare, the makers of Cenovis, said the brand was excited to have Tim on board. “Cenovis has been part of Australian families for more than 70 years; helping Mums, Dads and kids to start something healthy,” he said. “We are extraordinarily proud to welcome Tim Cahill, a favourite Australian son and father, into the Cenovis team.

Sanofi Consumer Healthcare wins three Product of the Year awards Sanofi Consumer Healthcare had three products recognised in February at the 2014 Product of the Year awards. Leading research company Nielsen surveyed more than 16,000 household shoppers for the nation’s largest consumer survey of product innovation, which reviews new products against criteria such as trial performance, value for money and overall satisfaction. The resulting 43 winners across as many categories represent the most innovative and exciting new products on the Australian market today. Three Sanofi Consumer Healthcare brands took out awards:

•• OTC Medicine, Hydration – Gastrolyte Jelly-Ice Blocks •• Adult Health and Wellbeing – Nature’s Own Complete Sleep Advanced

•• Kid’s Health – Cenovis Kids Vita Fizzies Multivitamin Director of Sanofi Consumer Healthcare Luke Fitzgerald said the awards were great recognition of how the company had been listening to consumers when developing new products. “Nature’s Own has been making high quality products for Australians for almost 40 years, and this Complete Sleep Advanced award is further confirmation that this popular, high quality product is helping our consumers,” Mr Fitzgerald said. “With our Cenovis children’s range, parents told us that there are times when it’s hard to ensure children are getting all the nutrients they need. Our products have been specifically formulated to provide parents with an option to provide their kids with a nutritional top up when they believe it’s needed.” Mr Fitzgerald said that it was great to see innovation recognised with an award going to the Australian first, Gastrolyte Jelly-Ice Block rehydration solution. “Parents told us that they want easy and efficient rehydration solutions when their children are sick and this product responds to their feedback. “We have a great team at Sanofi Consumer Healthcare and many people across the business worked hard to get these products to our consumers.” >> www. sanofi.com.au

PLACE YOUR NEWS You are welcome to submit your latest product launch, company news, information and/or updates of other pertinent information 200 words or less for positioning in this section of ITK. Please forward all content to Candice Radford on E-mail: Candice.radford@goldx.com.au

“We have partnered with Tim because he shares our values a commitment to family and health and well-being. 2014 will be a busy year for he and his family and we look forward to supporting them.” The partnership will see Tim appear in Cenovis television commercials, on in-store point of sale and in digital campaigns. He will also be helping out with exciting Cenovis promotions planned for later this year. “I think people will really love our new campaign with Tim and they will love our guest stars, Tim’s sons Kyah and Shae, who join him in one of the ads,” Luke said. Speaking about the partnership, Tim said: ‘It’s great to be part of the Cenovis family – I’m really excited about working with the team this year. As a father of four I know how important it is for my family to maintain our healthy lifestyle. It’s great to be working with Cenovis and helping other Australian families start something healthy.” Television ads will air from May and in-store point of sale will be available from May. >> www.cenovis.com.au

“We have partnered with Tim because he shares our values – a commitment to family and health and well-being.” Symbion chief to take on expanded role with parent company EBOS Limited, the NZ company which acquired Symbion Healthcare last year, has just announced that Symbion chief Patrick Davies will become the head of the EBOS Group later this year. It’s part of a series of succession planning moves which will also see EBOS chairman Rick Christie retire at the company’s annual general meeting in October 2015. Longstanding EBOS MD and CEO Mark Waller will then take over the role of Chairman in 2015, after having retired from his managing director role at the conclusion of the group’s full year result presentations in August 2014. He’ll then “undertake a key project role for 12 months to work on driving the next phase of the EBOS growth story”. Davies, who’s currently heads up Symbion, will become CEO of EBOS Group, while Symbion’s chief financial officer John Cullity will become the CFO of the overarching business. EBOS this morning reported a net profit after tax of $49.4 million for the six months to 31 December, surpassing forecasts in its prospectus supporting the Symbion acquisition. >> www.pharmacydaily.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

WHAT’s NEW & company news

Ego salve to ease eczema Ego Pharmaceuticals – one of Australia’s leading skincare companies – has pledged its support for the inaugural Eczema Awareness Campaign. The campaign, run by the Eczema Association of Australasia Inc, will spread the message about ways to manage eczema leading into winter. The association’s president Cheryl Talent welcomed the involvement of the company, which has a long association with providing products for eczema and sensitive skin through Australian pharmacy.

“Australia has one of the world’s highest incidences of eczema – a recurring, non-infectious, inflammatory skin condition. One in three Australians say they had suffered with it at some stage.”

“Some of the most commonly used creams to treat eczema may be making it worse. We are pleased to be working with Ego whose QV range is suitable for use by eczema sufferers,” Cheryl said. Australia has one of the world’s highest incidences of eczema a recurring, non-infectious, inflammatory skin condition. One in three Australians say they had suffered with it at some stage, she said. “Winter is an even more problematic time for eczema sufferers. We’re pleased to have this forum to talk about the facts and get the message out there for sufferers that there is help at hand,” said Cheryl, an eczema sufferer since birth. The managing director of Ego Pharmaceuticals, Alan Oppenheim, welcomed his company’s involvement in the Eczema Awareness Campaign, which will run from April 21-May 16. “It is an extremely worthy cause. We are pleased to pledge our support to the great work done by the Eczema Association. In fact, our company was built on the need to restore and maintain healthy skin so our missions are very much aligned,” Oppenheim said. The Eczema Association provides support and education to their members, the general public and health professionals. >> www.eczema.org.au

Ostelin – Helping develop strong babies Ostelin, Australia’s #1 Vitamin D brand and leading bone health expert*, is proud to announce the launch of a new pregnancy formula; Ostelin Pregnancy Essentials. It contains high strength Vitamin D for baby bone development, plus Folic Acid, Iodine and Omega-3 DHA. This specialised formula was developed with the input of leading medical experts, Professor Peter Ebeling MBBS MD FRACP, Associate Professor Craig Munns MBBS, PhD, FRACP and Associate Professor Glyn Teale MBBS, MD, FRACP, who were consulted to review evidence supporting important nutrients for healthy pregnant women. They recommended these four nutrients as they are vital for a strong healthy pregnancy and baby development and may be difficult to get from diet and lifestyle alone. Ostelin - the branded capsule more Australians choose for quality vitamin D supplementation*.

>> www.ostelin.com.au

AUSTRALIANS WELCOME A WORLD-FIRST IN PAIN RELIEF Launched at the end of February, MAXIGESIC® is poised to shake up the nations’ pain relief market by offering the only analgesic in Australia to combine Paracetamol and Ibuprofen in one tablet to give consumers at least 32% more pain relief1. Dr Hartley Atkinson, the Perth-born inventor and developer of MAXIGESIC®, says his company developed the ground-breaking MAXIGESIC® while trying to find a more effective alternative to combination painkiller products. “Combination products traditionally use Paracetamol or Ibuprofen as the basic active ingredient then add codeine to amplify the effect. However, codeine is an opiate and there is growing concern over its potential for misuse,2” said Dr Atkinson. In a world-first, MAXIGESIC® takes two trusted active pain ingredients, Paracetamol 500mg and Ibuprofen 150mg, and combines them in a specific formulation – without codeine. Together they work in different, complementary ways to reduce pain and inflammation and provide significantly more effective pain relief than either Paracetamol or Ibuprofen alone1. MAXIGESIC® is now available in leading pharmacies throughout Australia as a Pharmacist-Only (S3) Medicine in packs of 10, 16 and 30 tablets. MAXIGESIC® has been sold in New Zealand pharmacies since 2009, where it recently reached the milestone of 10 million tablets sold. AFT Pharmaceuticals has successfully out-licensed the MAXIGESIC® intellectual property to over 40 countries and through these licenses is well-positioned to tap into the US$4.1billion global over-the- counter global painkiller market.

MAXIGESIC® was invented, developed and patented by AFT Pharmaceuticals, a privately-owned Australasian pharmaceutical based in Sydney and Auckland. AFT Pharmaceuticals is a true success story. Beginning with a humble $50,000 start-up in Dr Hartley Atkinson’s home garage in 1997, AFT is now an originator of ground-breaking medicine with turnover over A$60 million. AFT Pharmaceuticals has over 20 products listed on Australia’s Pharmaceutical Benefits Scheme (PBS) and sells medicines in more than 1,000 public and private hospitals across Australia. The company has recently opened offices in Kuala Lumpur and Singapore. Maxigesic® film coated tablets (Paracetamol 500mg and Ibuprofen 150mg; 10s, 16s and 30s) are a Pharmacist Only (S3) Medicine for the temporary relief of pain and reduction of fever. Please review the full PI before recommending, available on request from AFT Pharmaceuticals. 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. Do 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 you have kidney disease. Do not use if you have asthma or a stomach ulcer. Do not exceed the daily recommended dose. Always read the label and use strictly as directed. If symptoms persist or side effects develop, contact your healthcare professional. AFT Pharmaceuticals Pty Ltd, Sydney. Patent No. 2005260243.

>> www.aftpharm.com references 1 Result achieved in a trial of post-operative pain relief after removal of 1-4 wisdom teeth. Expressed as the mean time adjusted VAS pain scores 48 hours post-op at rest. 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. Doses given as Paracetamol 4000mg or Ibuprofen 1200mg per day in 4 divided doses. 2 http://medisafe.govt.nz/profs/class/mccmin25jun2008.htm

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

WHAT’s NEW & company news

Makers of Gastrolyte launch late night recovery product RecoverlyteTM, from the makers of Gastrolyte®, is an Australian-first formulation which features a four-way blend of electrolytes, vitamins, minerals and amino acids to help the body recover from a late night out. Scientifically developed, Recoverlyte is a tropical flavoured effervescent powder designed to restore the body’s natural balance and provide a much needed energy boost when a late night involves lack of sleep, alcohol or vigorous activity, such as dancing. The product launch follows new consumer research which suggests that following a late night out, a third (33%) of Aussies opt to remain in bed or motionless on the couch while more than a fifth (22%) ditch the healthy diet in favour of calorie laden food.1

Luke Fitzgerald, Director of Sanofi Consumer Healthcare which produces Recoverlyte, said: “Recoverlyte offers a solution for busy individuals who can’t afford to lose a whole day after a late night out.” Recoverlyte’s scientifically developed formulation provides:

•• Electrolytes to help restore your body’s natural electrolyte balance •• Vitamin Bs to help mental performance, assist with energy production and normal body function

•• Amino Acids - the building blocks of essential proteins •• Folic Acid to assist in metabolism of amino acids •• Minerals to reduce muscle cramps and weakness, and support proper body function

•• Vitamin C to help maintain immune function •• When taken as directed with 250mL of water, Recoverlyte helps replenish your body’s fluid levels. Pharmacists will be supported with in store point of sale, including a specific branded counter display unit.

“Recoverlyte offers a solution for busy individuals who can’t afford to lose a whole day after a late night out.”

>> www.recoverlyte.gastrolyte.com.au/

1 Research was conducted by Pure Profile on behalf of Recoverlyte between 11-15 October, 2013 and surveyed 1000 Australians nationwide

Not All Probiotics Are The Same WHY RECOMMEND ND INNER HEALTH PLUS? US? Inner Health Plus is an exclusive probiotic, developed evelo ev eloped ped usive us ive and and by the probiotic experts. It contains the exclusive cidoph cid ophilu iluss extensively researched strain Lactobacillus acidophilus (NCFM®), and Bifidobacterium lactis (Bi-07).

Have your customers recently taken antibiotics?

Do your customers suffer from gas or bloating?

Want to improve general wellbeing?

Want to maintain healthy digestion and immunity?

Always read the label. Use only as directed. If symptoms persist consult your healthcare professional.

Find out the full benefits, visit: www.ethicalnutrients.com.au

IHP2877 - 01/14 /14 1

Not all probiotics do the same thing and it’ss no nott just just the number of good bacteria that counts. Recommend omme mmend nd probiotics with scientifically researched and va validated valid lidate ated d strains such as Inner Health Plus, and help p restore restore rest ore your customers digestive balance and improve rove ro ve the theirir general wellbeing.

www.innerhealth.com.au

After Hours Interview

A 470km Epic Bike Ride for a remarkable cause… in 1 day! BY SEAN TUNNY Editor, Gold Cross Products & Services Pty Ltd

Imagine for a moment, rising one Saturday morning and staying awake for the next 24 hours. If that does not appear daunting enough for those of us who may function on just a few hours’ sleep, consider riding a push bike for the next 24 hours, not only staying awake, but amassing an extraordinary 470 km around mountainous terrain in Brisbane, some 17 950 metres of total elevation. Michael Owen completed this phenomenal achievement at 9 am on Sunday, 9 February in front of his wife, many friends and supporters. Needless to say, Michael did not ride home! For those of us who have been touched by cancer personally or have family or friends who have suffered the pain and agony firsthand, Michael’s story, as we will learn in this article, is no less gut-wrenching. In 2011, suffering from bouts of dizziness and loss of balance, Michael was diagnosed with a form of brain cancer known as Anaplastic Astrocytoma. As some Pharmacists may know, Anaplastic Astrocytoma is a primary grade III (malignant) brain tumour. Anaplastic Astrocytoma comprises about 4 percent of all primary brain tumours diagnosed in Australia. Recently, we had the opportunity to speak with Michael about his cancer, life before and after the diagnosis, his prognosis, treatment, and the motivation for his recent epic bike ride. Editor: Congratulations Michael on your phenomenal 24-hour ride. What an inspiration. Such a great cause in the fight against cancer. Michael: Thanks. It really is a huge relief to check that box for both surpassing the 50 laps of Mount Coot-tha and exceeding my expectation for fundraising. I’d have to say though, that it was a big effort from all involved—from those who fed me,

driving the follow safety car, to those that supported my spirits lap after lap. Editor: How did you get your nickname “Mowen”? Michael: Growing up, there were a lot of “Michaels” in my class at school so people joined my first initial to my last name—nothing too exciting. I didn’t pass on that information when I started working, or anywhere really, but it always seems to end up sticking wherever I go. Editor: To go back a little, can you please tell me briefly about your life prior to 2011? Michael: Cycling wise, I had spent many years on the track and did a little bit of road riding. It was a tough era though to move forward, so I made the decision to go to University and study Engineering. In hindsight, a good choice, given that we now know what it takes both physically and medically. I ended up working in the oil & gas, and mining minerals sector and found myself working hard … really hard. I suspect that this is what didn’t allow me to see the warning signs. I was putting in 80+ hours a week at work, leaving little time for anything else, and therefore one would expect headaches and not be surprised that they were always there. Editor: On Thursday 3 November you received a diagnosis that was, to be blunt, shattering. Can you share a little about the events leading up to and following this diagnosis?

Michael: I guess it’s easy to see the warning signs now. I had been having headaches which were the primary reason I went to the doctors. Looking back though, I had been bumping into things a lot and my balance wasn’t quite right. It turns out I had pretty well lost my peripheral vision, but at the time, bumping into things didn’t concern me—I was always a little clumsy. After I was diagnosed, I kind of shut down. I didn’t want to talk to anyone about it, and well … I didn’t. I finally spoke about it the following Tuesday once I had got my head around what had happened and what I had to do to go forward. From there it was all about getting in for treatment. Editor: You were advised that even with treatment, you had a 50% chance of surviving just 1 year and less than a 2% chance of surviving beyond the second! Michael: As someone pointed out to me … at least you’ve got a chance! In the end those statistics didn’t mean much to me as I knew I had to stay focused, stay positive, and do everything in my power that I had control over to beat this disease. Editor: How did the radiation and aggressive chemotherapy affect you? Michael: Radiation caused a swelling, and even though I was on a plethora of substances to assist, it did not quell the headaches. Potentially worse was the claustrophobic

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

After Hours Interview

“In the end the statistics didn’t mean much to me as I knew I had to stay focused, stay positive, and do everything in my power that I had control over to beat this disease.”

feeling of the daily radiation—I’m not very adept at sitting still. Chemotherapy? Not fun … but not as bad as I expected. Those initial weeks were the worst, but eventually feeling bad became the norm and in the end it was manageable with rest and acceptance that I could not control how badly I felt. Editor: The support of your wife, family, friends and supporters is so fundamentally important, is it not? Michael: It really is and in a way it’s much harder for everyone else. Firstly, I’m stubborn and don’t really like help, and secondly, because they are not in control, they are left feeling helpless. It really was all the little things that added up to one big burden off my shoulders. It was filling my fruit bowl, making sure my freezer was full of enriched meals or simply just being there with advice and words of encouragement about people they knew that had survived. Editor: How did the concept of an epic 24-hour bike ride, a 9.4 km gruelling loop around some of Brisbane’s toughest terrain, come about? Michael: Well, a friend of mine, Chris White, who is also a cancer survivor, got me involved in the Beat Cancer Tour in Adelaide where each participant rides the full course of the Tour Down Under to raise funds for Cancer Council. This ticked a lot of boxes: riding, catching up with old friends and raising money for cancer research and support. Essentially anyone that knew me would have thought this was more of a holiday than a challenge. The idea came about over coffee one morning, discussing some guy that had cycled 37 laps of Mt Coottha and they thought that was impressive. I agreed. Then I thought … I reckon I could do 50 and put a time limit on it of 24 hours.

It seemed do-able in my head but lots of people advised me otherwise. In the end … 51 was the number. Editor: How do you honestly prepare for such an event? Training, nutrition, equipment etc. Michael: To be honest, I did little in preparation of training. I hoped that the base miles were in the legs and that would be enough to get me over the line. Nutrition though, I planned to the calorie. I rode some test laps at what I thought my pace would be, and using a powermeter was able to fairly accurately determine my calorie burn rate. From there it was simply eat enough food and plan it out. Given it was 24 hours, I wanted to make sure I ate real food rather than sports food as I knew it would be easier to digest; however, in the end I didn’t really want to eat and was forcing it down after 12 hours. Equipment selection was where I was lucky. Riding for the Rapida Cycling Team, I’m fortunate that we are supplied with BH Bikes, Santini clothing and Lazer helmets. The clothing is very comfortable, and in addition the BH Ultralight bike lives up to its name, meaning I didn’t have to carry any excess weight up the hill. Editor: Can you give us a brief outline of the 24-hour ride on the actual day? Michael: Lap 1 we started at a blistering pace and ended up dropping all but two supporters on the first climb … I got in trouble. Lap 2 we had a minor collision with a bush turkey that came out of nowhere. From there though, I quickly settled into a comfortable pace—about 2 minutes faster than planned, but I knew that would come in handy later. That pace held until dark—we took breaks for 15 minutes every four hours for extra food

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

and bathroom breaks. Once it was dark, the descending became difficult and I became reliant that I already knew so much of the course from all those daylight hours. One concern was my reaction times, which were slow, particularly if any wildlife ran out into our path—we were lucky. There was a flood of people that came out to support us during the night, from people dressed up in chicken suits to the girls from My Sweetopia visiting to bring coffee and food for everyone. The last few laps after the sun rose were good and bad … happy to see the sunrise but still knowing I had 4 hours to go. On the last lap there were a huge number of people waiting for us to roll in … clapping and cheering—it was all very embarrassing. Thankfully Cibo espresso were there to deflect the attention from me with Italian delicacies … I was thinking about a cannoli for several of those last laps. Editor: We have no doubt you did not require any rocking on Sunday evening? Michael: Weirdly, I went home, had two hours sleep and then slept normally that night. Nutrition must have been spot-on as I only lost 600 grams and I was able to do a slow ride on the following Tuesday … VERY SLOW …! Editor: You are currently cancer free? Michael: Sure am … which is all one can hope for, for now. Now it’s all about making it to 5 years. Editor: On behalf of everyone, congratulations again. Your story is an inspiration and on behalf of community pharmacists throughout Australia, we sincerely wish you good health and happiness. Michael: Cheers

60 SECONDS WITH

60 SECONDS WITH... Chris Reilly Pharmacist Alive Discount Pharmacy Smithfield I decided to become a pharmacist because... I have always been attracted to the sciences and combining it with helping and talking to people seemed like a good mix.

Switzerland and Tuscany and combined

I have been working as a pharmacist for... 7 and ½ years

market news...

What I like best about my job is... The ability to provide advice to people and achieve better health outcomes!

Over the next 3 years in pharmacy,

My favourite hobby is... Fishing. If only I had a boat… (Subtle hint to my wife Renae)

money. Continued price disclosure affecting

My favourite book is... Marching Powder by Rusty Young.

efficiency and cost control will be imperative.

My best getaway ever was... I find it hard to split the 3 months I spent in Europe travelling around with some school mates in 2008 or my honeymoon in 2012 where we went to Ireland,

starting a career in pharmacy, it would be...

it with a good friend’s wedding. How I keep myself updated to the AJP and Retail pharmacy predominately.

I predict... That if I knew that I could make a lot of margins but hopefully the 6CPA can offset some of these. Continued focus of business

If I could give any advice to someone You are going into a great industry where you can make a difference to people’s health and well-being. How you do that is up to you!!

HEALTH CALENDAR

HEALTH CALENDAR April–May 2014

Food Allergy Week 12 – 19 May Food Allergy Week is the national initiative to raise awareness and money to support Australians with food allergies - a widespread public health issue that is on the rise. >> www.allergyfacts.org.au/the-media/foodallergy-week-2014

Kidney Health Week

Heart Week

25 – 31 May

4 – 10 May

Kidney Health Week is a national awareness campaign to promote good kidney health, held annually in the last week of May. 1 in 3 Australians over the age of 25 is at increased risk of developing kidney-related disease and so our annual Kidney Health Week is a key time to educate the general public on the risk factors.

Each year, almost 10,000 Australians die of a heart attack. And more than 1 million Australians aged 30-65 are at high risk of having a heart attack or stroke — but they may not even know they’re at risk.

>> www.kidney.org.au/newsevents/ kidneyhealthweek/tabid/648/default.aspx

>> www.heartfoundation.org.au

Ride for Recovery 21 – 27 April

Macular Degeneration Awareness Week 25-31 May The Macular Disease Foundation Australia is reminding people over 50 years to have their eyes tested and macula checked in the lead up to Macular Degeneration Awareness Week. >> www.mdfoundation.com.au/page1220291. aspx

The Ride for Recovery is a joint venture between the Leukaemia Foundation and the Myeloma Foundation to raise awareness of blood cancers in Australia and raise funds for blood cancer patients’ services. >> www.everydayhero.com.au

Tracky Dack Day Any day in May

65 Roses 30 May By taking the 65 Roses Challenge you will help us raise money for vital services and programs, advocacy and research that helps to extend the lives of Australians living with Cystic Fibrosis. >> www.65roses.org.au GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

Dack up to show your support for kids in hospital! TLC for kids provides the only emergency support available in Australian hospitals for distressed kids and their families. Walk in their shoes for just one day and know you’re making a difference. The more people who register, the greater the number of smiles TLC can deliver. >> www.tlcforkids.org.au/tracky-dackday-2014

CLASSIFIEDS FOR SALE 2 x Kyocera Toners TK 554 Cyan 2 x Kyocera Toners TK 554 Magenta Pariet 20mg tabs (30) x 90 boxes Exp: 07/14 – Price $13.00

2 x Kyocera Toners YK554 Yellow

Karicare Aptamil Pepti Junior Gold 450g tin x 16 tins Exp: 28/09/14 - Price $9.50

Selling for $130.00 each + GST +Postage 2 x Kyocera Toners TK554 Black - Selling for $100.00+ GST+ Postage

Voltaren Optha drops (30x0.3ml) x 1 box Exp: 09/15 – Price: $18.50

Contact: Bianca Mills, The Centre Pharmacy, Tamworth NSW, Ph: 02 6766 1818, Email: tamworth@thecentrepharmacy.com

Voltaren 50mg (50 tabs) x 30 boxes Exp: 04/16 – Price $3.70 Contact: Ali, Bunbury Drive In Chemist, Ph: (08) 97912447, Email: bdic@ixia.com.au

6 x Predsol Retention Enemas 100ml 7 Exp: 10/2014 – Cost $20.00

1x Metagenics ThermoPhase Detox Vanilla 686g powder Exp: 31/8/14 $30 (W/S ex GST $44.20) 2x Metagenics G-Tox Express 280g Exp: 31/9/14 $30 (W/S ex GST $40.60) 1x Metagenics CalmX 270g Exp: 31/7/14 $15 (W/S ex GST $25.40)

1 x Pentasa Sachets 2g 60 Exp: 11/2014 – Cost $220.00 Contact: Andrew Silvan, Claisebrook Cove Pharmacy, Ph: (08) 9325 5247

3 x Jurnista 64mg 14 ‘s Exp: 06/2014 - 20% discount (postage included) Contact: Trevor at Craig Pharmacy, Ph: 08 8255 2577

1x Metagenics Ultra Probioplex 150g powder Exp: 30/6/14 $20 (W/S ex GST $30.25) 1x Metagenics PhytoPro 60 Tablets Exp: 30/6/14 $15 (W/S ex GST $22.40) Contact: Sam, Caringbah Compounding Pharmacy Sydney, Ph: 02 95246795, Email: sghostin@gmail.com

Xeloda 500mg 120 tabs Exp: 07/2015 – Cost $550.00 Salofalk 4g Enemas qty 28 Exp: 05/2015 - $350.00 Contact: Praneeth, Health Focus Pharmacy Geraldton, Ph: 08 99214151, Email: hfpgeraldton@bigpond.com

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

CLASSIFIEDS (cont)

FOR SALE 1 x AUBAGIO 14mg Tabs (3X10 tablets) Exp 02/15 40%OFF

BRAND NEW PRINTER TONERS - MAKE US AN OFFER

1 x AUBAGIO 14mg Tabs (3x10 tablets) Exp 04/15 40%OFF

TK310 x 3, TK320 x 3, TK594K x 4, TK594Y x 4, TK 594M x 4, TK594C x 4

1 x AUBAGIO 14mg Tabs broken pack (2x10 + 6 tablets) Exp 04/15 50% OFF

TK554K x 2, TK554C x 2, TK554M x 2, TK554Y X 2, TK564K x 8, TK465C x 3, TK564M x 3, TK564Y x 8

1 x INVEGA SUSTENNA 50mg Inj Exp 05/15 30%OFF Contact: Denny, Ph: 08 94994074, Email: hppharmacy@amnet.net.au

Contact: Nicole or Elle, Ph: (02) 4928 1328, Email: stocktonchemmart@gmail.com

1x Zoladex 10.8mg Exp: 03/2015 – Cost $950.00

CORAL COLOURS No longer stocked.

1x Strattera 100mg 28 Exp: 01/2015 – Cost $100.00

Most of the range available, sell all cost – 15%

1x Serenace 5mg 10 amps Exp: 05/2014 – Cost $8.00

Assorted L’Oreal & Maybelline cosmetics & skincare also available Details on enquiry.

1x Stalevo 200/50/200mg 100tabs Exp: 05/2014 - $100.00 All prices include delivery cost, please call Nairne Pharmacy at 08 8388 6422 or 0422 066 022, Email: limciacen@yahoo.co.uk

1 x Complete new set of toners (TK520K, TK520Y, 520C, 520M) to suit a Kyocera FS-C5015N colour printer. Purchase price $727.50 reduced to sell $520.00 POSTAGE INCLUDED Contact: Lorraine, Ph: 08 9776 1054, Email: pembertonpharmacy@westnet.com.au

2x Co-Diovan 80/12.5mg 28 tabs Exp: 30/11/2014 2x Lariam 250mg 8 tabs Exp: 30/11/2014

Contact: Donna, Stud Park Pharmacy Melbourne, Ph: 03 9764 2933, Email: pharmacy@studparkpharmacy.com.au

2 x FS-2000D Ecosys printer toners. Never used, good condition. Paid $165.00 each, will sell for $132.00 each. Contact: Rowan Conn, Texas Pharmacy, Ph: 07 4653 1367

Forteo Multidose PFP 250mcg/mL, 2.4mL x 1 Exp: 09/14 Refrigerated Item Cost: $350.00 Contact: Jo Khoo, Tom Lane Pharmacy, Ph: 03 9434 4333 , Email: tomlane@amcal.net.au

2x Stalevo 200/50/200mg 100 tabs Exp: 31/12/2014 Price: 20% off W/S price Contact: Ms Daynaz Ejtahed, Price Line Pharmacy Waterford Plaza, Ph: 08 9450 5115, Email: waterfordpharmacy@frednet.com.au

1x Topamax 200mg Exp: 08/2014 - Cost $50.00 1x Seroquel XR 400mg Exp: 09/2015 - Cost $150.00 Contact: Vanessa, Tran Priceline Pharmacy Top Ryde, Ph: 02 9807 3806, Email: topryde.pharmacy@nunet.com.au

5 x Humulin 30/70 Penfill Exp: 10/14 - 50% off o.n.o. ($100 total) 3 x Mixtard 30/70 Penfill Exp: 02/15 - 50% off o.n.o. ($60 total)

1x Aldara pump-single (exp 6/14) $60.00

1 x Campral 180 tabs Exp: 01/17 - 10% off o.n.o.

4x Avanza Soltab 45mg (exp 4/14) $28.40 each

1 x Lyrica 300mg Exp: 01/16 - 10% off o.n.o.

3x Risperdal Quicklet 0.5mg (exp 12/14) $6.50 each

1 x Seroquel XR 150 Exp: 08/15 - 10% off o.n.o.

5x Trileptal 300mg (exp 5/15) $95.00 each

1 x Neotigason Caps 25 Exp: 09/15 - 20% off o.n.o.

10x Ventolin Nebules 2.5mg/2.5ml (exp 3/15) $6.50 each

1 x Protos Exp: 10/15 - 10% off o.n.o.

2x Budamax Nasal spray (exp 2/15 and 9/15) $26.00 each

8 x Gabapentin Sndz 300mg Exp: 10/14 - $10 each o.n.o. **label remnants

Contact: Tracy, Wizard Warehouse Girrawheen, Perth, WA, (08) 9247 1688, Email: pmanager.girrawheen@wizardphy.com.au

1 x Byetta 5 mcg Exp: 10/15 - 10% off o.n.o. 1 x Byetta 10 mcg Exp: 01/15 - 15% off o.n.o. 2 x Comtan label remnants Exp: 03/15 - 50% off o.n.o. 1 x Zyprexa Zydis wafer Exp: 06/15 - 20% off o.n.o. Contact: Quin Lee Jeffery, Ravenswood Pharmacy, Ph: (08) 9537 6958, Email: ravenswood@vivochem.com.au Note: We have more dispensary items on clearance - please email to request a full list at negotiable prices.

Vimpat 200mg x 2 Exp: 08/14 and 06/15 – Cost $200.00 each (list cost $318)

PLACE YOUR FREE CLASSIFIED ADVERT If you would like to place your free classified ad, forward any items for sale to Candice. Email: Candice.radford@goldx.com.au

BROUGHT TO YOU BY:

Contact: Louise, Redbank Plains Day and Night Pharmacy, Ph: (07) 3814 3343

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 35 : APRIL / MAY 2014

Our TV ADVERTISING draws customers to your store.

Our TRAINING

enables you to give them the best advice.

Our COMMITMENT

to you ensures they come back to you!

AS SEEN ON TV 1 teaspoon1 or just 4 capsules provides 2.7 grams of omega-3 (EPA/DHA); the dose research suggests helps to reduce joint inflammation associated with arthritis. - Arthritis Australia2

SUPPORT THE FISH OIL THAT SUPPORTS YOUR STORE! For a quality fish oil that delivers results, purity and repeat business; you can rely on Ethical Nutrients! Supported by a national multi-million dollar TV and print campaign; Ethical Nutrients Hi-Strength Fish Oil is a therapeutic dose of omega-33 EPA and DHA that exceeds Australian standards for purity and is nitrogen flushed for exceptional stability and high quality results. Ethical Nutrients Hi-Strength Fish Oil is only available from Pharmacies and Health Food stores, where your customers can receive informed advice; and you can be sure they come back to you, not a nearby supermarket.

www.ethicalnutrients.com.au

BEST PRODUCTS BEST EDUCATION Industry Pulse independent research shows Ethical Nutrients, yet again, as the BEST SERVICE leading supplier to Pharmacy providing unparalleled service excellence and product training for the 4th consecutive year!

Ethical Nutrients offers professional natural medicine training for all staff in your store in a variety of formats to suit the varied needs of your staff: • Online Learning Modules • In-Store Trainings • Training Evenings • itherapeutics.com.au

1 One metric teaspoon is equivalent to one 5mL measuring cap. Arthritis Australia is an independent organisation and does not endorse any particular brand of fish oil. 3 Omega-3 fats have not been studied in all forms of arthritis.

Always read the label. Use only as directed.

ETH6277 - 02/14

YOUR NATURAL BUSINESS PARTNER