In The Know April May 2017 by Gold Cross Products & Services

ISSUE #53 : APRIL/MAY 2017

IN THE KNOW

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CONTENTS

AFTER HOURS 62 GREAT OCEAN ROAD RUNNING FESTIVAL BUSINESS 12 CREATING SUCCESS FROM THE INSIDE OUT 22 AUTOMATION FOR YOUR PHARMACY

SEAN TUNNY Editor, Gold Cross Products & Services Pty Ltd

For the overwhelming majority of pharmacists, pharmaceutical companies and other stakeholders in our profession that I speak with regularly, it is acknowledged that the industry is undergoing significant change. Issues surrounding transformation, PBS reform, competition, leases, margins, staffing and business process are at the forefront of such discussions. Phil Chapman from Lease1 presents a must read business feature in this edition outlining the importance of adapting your pharmacy business now for profit. As outlined in ITK, Phil will be holding a webinar for just one hour on April 20th covering a host of critical elements of leasing and equipping you with action steps to a better lease. As this edition of ITK goes to print, APP 2017 has just been held on the Gold Coast, with delegates enjoying an event punctuated yet again by an outstanding line up of speakers in a terrific venue. The event continues to grow with a new date set for May 2018 to accommodate the Commonwealth Games. Our continuing professional development modules continue to be popular, with the first module on Asthma and COPD and the second on Community Pharmacy in the digital age. In this edition, we welcome editorial from the National Australian Pharmacy Students’ Association or (NAPSA) as it is commonly referred to. Shefali presents an insightful business editorial on the associations’ role in creating tomorrow’s pharmacists. We had the opportunity to speak with SkinB5 on their role in pharmacy with a product package that is tailored to a professional setting such as pharmacy. May I also encourage you register for ITK Connect which is a digital platform and enjoys tremendous pharmacist support. A weekly newsletter is sent covering professional, business and category information relevant to your pharmacy. Finally, a sincere thank you to the many people who make such a valuable contribution to this publication, including readers, contributors and media partners alike. Best regards, Sean Tunny Editor - ITK Publications

BROUGHT TO YOU BY:

26 FINANCIAL METRICS AND THE PHARMACY MARKET 30 NAPSA’S ROLE IN CREATING TOMORROW’S PHARMACISTS

32 HOW MANY INFLUENZA VACCINATION APPOINTMENTS WILL BE MADE ONLINE IN 2017? 44 COMMUNITY PHARMACY IN THE DIGITAL AGE

HEALTH 20 HEALTHY MAMA, HEALTHY BUB: WHAT YOU SHOULD BE DISCUSSING WITH YOUR CUSTOMERS 38 THE ROLE OF PROBIOTICS IN INFANTS AND CHILDREN WITH DIARRHOEA 40 VACCINATION VITAL FOR PEOPLE WITH ASTHMA

50 PAUSE 4 PARKINSON'S NEWS 3

COMMUNITY PHARMACIES COMPLEMENTARY MEDICINES AND TRUST

PRODUCT INSIGHT 52 SOUTHERN NATURE QUALITY NATURAL SOLUTION 53 COMPOUNDING FOR PAEDIATRICS

REGULARS 56 INDUSTRY NEWS AND UPDATES 58 60 SECONDS WITH ... 59 PRODUCT SPOTLIGHT 63 HEALTH CALENDAR 66 BUSINESS DIRECTORY CONTINUING PROFESSIONAL DEVELOPMENT 7

ASTHMA AND COPD - CLINICAL REFRESHER AND INHALER UPDATE

32 DIGITAL TRANSFORMATION IN AN AGEING DEMOGRAPHIC LANDSCAPE

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

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

DESIGN: BOOST Design 0431 609 683 Email: boostdesign@optusnet.com.au www.boostgraphicdesign.com PRINT & Fergies DISTRIBUTION: 07 3630 6500 | www.fergies.com.au

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

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

NEWS

COMMUNITY PHARMACIES Complementary Medicines and Trust GEORGE TAMBASSIS National President of The Pharmacy Guild of Australia

EARLIER THIS YEAR, ABC TV’S FOUR CORNERS FEATURED A PROGRAM ON COMPLEMENTARY MEDICINES, WHICH WAS WIDELY EXPECTED TO BE AN ATTACK ON COMMUNITY PHARMACY BUT WHICH, IN FACT, HIGHLIGHTED THE IMPORTANT ROLE OF PHARMACIES IN ADVISING PATIENTS ON ALL ASPECTS OF MEDICINES, INCLUDING COMPLEMENTARY MEDICINES.

At the Guild we believe it is essential that consumers have access to objective, informed advice about complementary medicines, and by far the best place to obtain that advice is at a community pharmacy. A range of complementary medicines are available through most community pharmacies in Australia, where pharmacists and pharmacy staff play an important role in providing advice to consumers about these products, and about any interactions that may occur with other medicines they may be taking. The Four Corners program described complementary medicines as a $4.7 billion industry — and it’s not going away, no matter how much its detractors wish it would disappear. Consumers want reliable information about complementary medicines and so do pharmacists. Consumer research clearly shows that consumers expect community pharmacies to stock these products in an environment where they are able to seek advice from a trusted health professional. The constructive message to emerge from the Four Corners program was that the evidence base and labelling of therapeutic products are areas where we can improve our

already world-class regulatory system — for the benefit of all. The Guild’s submission to the Pharmacy Review made this recommendation: to provide consumers with the necessary confidence regarding the safety, efficacy and responsible marketing of complementary medicines. It should be ensured that the Therapeutic Goods Administration implements strong and transparent licensing and marketing arrangements for these products. The important role of pharmacists in relation to complementary medicines was also acknowledged in the program through the results of a ‘shadow shop’ conducted by the CHOICE organisation. The CHOICE survey found: “With at least four years of university education in medicines and how they work, pharmacists are medicines experts. They're a highly trusted profession in the community and 91% of our shoppers felt the pharmacist they spoke to acted with genuine care”. This is backed up by a 2015 PricewaterhouseCoopers survey of 3000 consumers which was funded by the Department of Health as part of the Fifth Community Pharmacy Agreement Research and Development program. A key finding of that survey included: 90% of participants reported being satisfied with the interaction

they had with their pharmacist (based on the last three visits to the pharmacy). The main reason for satisfaction was that the pharmacist is knowledgeable and provides good advice. In the CHOICE ‘shadow shop’ of 240 pharmacies, each shopper was asked to approach the prescription dispensing counter and ask for advice from a pharmacist, stating, "I've been feeling really stressed lately, is there something you can recommend?" The CHOICE stated: “To be fair to the pharmacists, they were confronted with a customer prepared to purchase something to help them. It could be argued that by directing the customer to a product that the pharmacist believes might help, or at least do no harm, the customer would be better off than if they'd chosen a random product themselves”. As CHOICE found, the overwhelming majority of community pharmacists are motivated by genuine care and a desire to ensure the best possible outcomes for patients, based on evidence and transparency. Pharmacists and pharmacy staff are there to help consumers navigate through a complex health care market, utilising their expertise to help patients get the best health results.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

Be prepared to make the most of Flu season

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The simple yet powerful GObookings vaccination portal gives your pharmacy an affordable online presence, allowing you to better manage one-on-one appointments, 24/7.

Find out more at 1stgrp.com/pharmacy

BUSINESS

How many INFLUENZA VACCINATION Appointments will be made ONLINE in 2017? group

KLAUS BARTOSCH Group Co-Founder and Chief Executive Officer 1st Group Ltd

AT THE END OF THE DAY, WE GET HOME, PUT OUR FEET UP, FIRE UP THE LAPTOP/TABLET AND ORGANISE OUR SCHEDULE. WE BUY A TICKET TO A SHOW, BOOK A TABLE AT THE NEW RESTAURANT AND UPDATE OUR CALENDARS.

Powered by this trend, an increasing number of Influenza Vaccination appointments in 2016 were booked on-line, outside of business hours and without needing to make a phone call.

•

24/7 online booking capabilities can increase business to your practice due to additional appointment bookings occurring out of hours.

expensive servers or infrastructure, while providing an easy-to-use solution allowing for better management of one-on-one appointments, 24/7.

If your restaurant didn't take bookings online, would you expect to be busy? The same is true of the appointments at your pharmacy.

•

The 1ST Group’s online appointment booking system centrally collects data, such as appointment times and booking demographics, which translate into actionable insights to help grow your business.

The portal is highly customisable and configurable to meet your specific business needs. Our eCommerce platform enables your pharmacy to take pre-service payments.

Community pharmacies play a significant role in primary healthcare in Australia, while continuing to look for ways to innovate and develop improved, cost-effective health outcomes for their customers. The in-pharmacy influenza vaccination service is one example of this. At 1ST Group we provide community pharmacies with an integrated and collaborative approach to health care via a pharmacy vaccination portal. So, how can we help your pharmacy and why is the capability to take online appointments a critical part of the solution? •

When booking online, customers are able to secure an appointment at their leisure, at any time, from any internet connected device (phone, tablet, laptop, PC, etc!).

•

The 1ST Group’s online appointment booking system allows you to check your appointments and availability, using any device.

•

Customer cancellations are automatically updated, allowing another customer to take up the appointment slot.

•

Optional add-on modules can turbocharge your customer engagement, including bringing customers back for their regular periodic appointments cost effectively, easily and quickly.

Powered by GObookings, our online pharmacy vaccination portal gives your pharmacy an online presence without the need for

We take our customers’ privacy seriously. Data is collected in a secure system which is extensively used by government and corporate organisations. Also, our powerful business intelligence reporting platform provides you with invaluable insights into your data. We offer the ability to integrate this data with other systems, such as existing pharmacy applications, loyalty programs, Medicare and the Australian Immunisation Register. We understand that if a pharmacist or other qualified health practitioner is providing a vaccination service, there is a responsibility to ensure that certain actions are taken to record, share and retain information relating to the vaccination. Our technology makes these processes easier.

“We provide community pharmacies with an integrated and collaborative approach to health care via a pharmacy vaccination portal.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

BIG TICK OF APPROVAL NEW RELEASE:

Zamil Solanki Terry White Mt Gravatt

THE COMPLETE DISPENSARY AUTOMATION SOLUTION IS HERE! INTRODUCING Dose ConnectPRO

ELI MIN AT ER E HU RO MA R N

“This piece of software closes the loop of complete dispensary automation. No longer do we have to manually check off stock items. Once the stock has been loaded into our ROWA machine we can reconcile the stock received against the invoice from our suppliers at the click of a button. So much time is saved and the accuracy of the report is fantastic”

TED MA TO AU ION LLY UT FU SOL

Zamil Solanki from Terry White Chemists Mt Gravatt Plaza is the first pharmacy to implement Dose ConnectPro -

E AS RE LITY INC ITABI OF PR

Dose Innovations saw a need to provide a complete automation solution that has not been available to Pharmacies before.

TRACK & MANAGE YOUR INVENTORY

Q RE UICK CO NC STOC ILIA K TIO N

Dose Innovations have created the missing link that provides a seamless dispensary automation solution that is SIMPLE. Dose ConnectPRO is specifically designed to manage all of your dispensary stock at the click of a button. This software eliminates the need for manual invoice check off, it automatically reconciles your invoices to stock received and provides seamless integration with major wholesalers which allows accurate reporting at your fingertips.

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CONTINUING PROFESSIONAL DEVELOPMENT 7 7

Asthma & COPD Clinical refresher and Inhaler Update KATE ELLIS B.Pharm.

Learning Objectives: After reading this article, the learner should be able to: 1. Identify the clinical features and differences between Asthma and COPD. 2. Recognise the treatment goals and key therapies for Asthma and COPD. 3. Describe the key features of Asthma and COPD MDI and DPI inhalation devices. 4. Understand the pharmacists’ role in contributing to improved management of Asthma and COPD for patients.

National Competency Standards: 1.2, 1.3, 1.5

Accreditation number: G2017002 This activity has been accredited for 1 hour of Group 1 CPD (or 1 CPD credit) suitable for inclusion in an individual pharmacist’s CPD plan which can be converted to 1 hour of Group 2 CPD (or 2 CPD credits) upon successful completion of relevant assessment activities.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) ARE SIGNIFICANT PUBLIC HEALTH CONCERNS1. PEOPLE WITH ASTHMA ARE MORE LIKELY TO REPORT A POOR QUALITY OF LIFE AND COPD IS CONSIDERED THE SECOND HIGHEST CAUSE OF AVOIDABLE HOSPITALISATION2,3. FOR THIS REASON, ACCURATE DIAGNOSIS AND MANAGEMENT OF THESE DISEASES ARE PARAMOUNT. AS PHARMACISTS, IT IS IMPORTANT THAT ASTHMA AND COPD ARE RECOGNISED AS DIFFERENT DISEASES, WITH UNIQUE PATHOPHYSIOLOGICAL MECHANISMS AND EPIDEMIOLOGICAL FEATURES. IN THE PAST COUPLE OF YEARS IN PARTICULAR, THERE HAVE ALSO BEEN SEVERAL ADVANCEMENTS IN THE TREATMENT OF ASTHMA AND COPD WITH AN INFLUX OF NEW INHALERS AVAILABLE ON THE MARKET. PHARMACISTS ARE THEREFORE IN A KEY POSITION TO COUNSEL AND DEMONSTRATE TO PATIENTS ON THE EFFECTIVE USE OF EACH OF THESE INHALERS TO OPTIMISE TREATMENT OUTCOMES.

ASTHMA AND COPD WHAT’S THE DIFFERENCE? Both asthma and COPD are evidenced by coughing and wheezing, along with varying degrees of airflow limitation, mucous and inflammation4. They differ, however, in their clinical presentation, pathophysiology, lung function results and medication management4. Asthma more commonly develops in childhood, however, it can also be diagnosed later in adult life1,2. It is considered an allergic disease, with sufferers more likely to have a history of allergic conditions such as eczema or hayfever2. Asthma is characterised by airway hyper-responsiveness that leads to intermittent and usually reversible airway obstruction1. Thus when conducting a spirometry lung function test (spirometry measures how much and how quickly air can move out of the lungs), the airways may show some changes but these are mostly or completely reversible, returning to normal with medical treatment2. COPD on the other hand, is characterised by progressive and irreversible airway obstruction5-8. It is considered a chronic disease, usually presenting in subjects forty years of age or older5,6. The main cause of COPD is smoking1,7, with around 50% of all smokers developing some form of airflow limitation and 15-20% of smokers developing severe lung problems2. A summary of some key differences between asthma and COPD is available from table 1. Additionally, it is worth noting that although these definitions allow asthma and COPD to be recognised as distinct disease states, some people have a mixture of both asthma and COPD1,2.

Table 1 – Clinical Features of Asthma and COPD3,7 CLINICAL FEATURES

ASTHMA

COPD

Symptoms under age 40

Often

Rare

Smoker or ex-smoker

Possibly

Nearly all

Sputum Production

Infrequent

Common

Allergy (eczema or allergic rhinitis)

Common

Infrequent

Night time waking with breathlessness and/or wheeze

Common

Infrequent

Spirometry findings – Airflow obstruction following short-acting bronchodilator

Mostly reversible

Not fully reversible

TREATMENT GOALS AND THERAPY IN ADULTS Improved quality of life, symptom control and prevention of exacerbations and complications are the main rationale for drug use in both COPD and asthma7. The therapies used to achieve these goals in adults could be considered similar, however, the stepwise approach and application of these therapies are markedly different. In adult asthma patients, a short-acting beta agonist (SABA) such as salbutamol or terbutaline is used when required for symptom relief 4,7. Usage of this on more than two days per week (not including doses for preventing exercise-induced bronchoconstriction) is one sign that the asthma may not be well controlled4,7. The addition of an inhaled corticosteroid (ICS) is considered first-line maintenance therapy for those patients where asthma symptoms4 occur more than twice per month, they have been waking due to asthma in the previous month or they received systemic

corticosteroids within the previous year7. For patients whose asthma is still not adequately controlled with an ICS preventer, then the addition of a long-acting beta agonist (LABA) is considered using a fixed-dose combination inhaler if possible4,7. Dose increases and adjustments may then be made to the doses of combined ICS and LABA to achieve optimal asthma control4. If such control is achieved after two to three months and there is a low risk of exacerbations, the ICS dose may be slowly titrated down and the LABA ceased over a period of several months7. Due to raised concerns of asthma exacerbations and asthma-related deaths with LABA use, particularly when used without an ICS, asthma guidelines in Australia state that if using a LABA for asthma, it must always be used together with an ICS7. Note that tiotropium, a long-acting muscarinic antagonist (LAMA) in the specific Spiriva Respimat® formulation, is now marketed as an adjunct in asthma maintenance treatment for patients already receiving a high dose ICS and LABA7.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

CONTINUING PROFESSIONAL DEVELOPMENT

Cromones or montelukast are still options for asthma management therapy, however, they are considered less effective than low-dose ICS, and adding a LABA to ICS is preferred over montelukast7. Theophylline can be used for severe asthma, although it is not routinely recommended as beta2 agonists are preferred7. Omalizumab, a monoclonal antibody administered via subcutaneous injection, is reserved for specialist use in moderate to severe allergic asthma cases where there has been insufficient response to maximal asthma therapy and serum immunoglobulin E levels are raised7. The drug treatment regime for COPD, in comparison to asthma, is almost the opposite4. SABAs, most commonly salbutamol, are also used initially and throughout disease progression on an as needed basis7,8. In contrast to asthma, however, a short-acting muscarinic antagonist (SAMA) such as ipratropium can also be used in the initial management of COPD to relieve symptoms and improve exercise tolerance7. Beyond this for persisting symptoms, adding in a LABA or LAMA is the next step7,10. In contrast to their use for asthmatics, LABAs can be used alone (without an ICS) in COPD treatment. If the patient is still symptomatic, both LABA and LAMA may be used together, and if relief is still not obtained after this step, only then should an ICS be introduced to the regime (LAMA + LABA + ICS)7,9. The latest COPD-X guidelines have, however, noted that studies of ‘triple therapy’ including an ICS, LABA and LAMA in combination have revealed conflicting results10. It should also be of note that a SAMA such as ipratropium should be ceased or switched to a SABA if the patient at any stage is using a LAMA7. Evidence only supports the slow-release formulation of

"COPD on the other hand, is characterised by progressive and irreversible airway obstruction. It is considered a chronic disease, usually presenting in subjects forty years of age or older." theophylline in COPD, but with its narrow therapeutic range and potential for toxicity, inhaled bronchodilators are preferred when available7,10. Although oral (systemic) corticosteroids can be used in acute asthma and COPD exacerbations, they have no place in long term maintenance therapy7,10.

INHALER UPDATE Over the recent years there have been several updates to both drug therapies and inhaler devices available for the treatment of asthma and COPD. The types of inhaler devices (excluding nebulisers) can be separated into two broad categories, which are metered dose inhalers (MDI) or dry powder inhalers (DPI). Pressurised MDIs are the most frequently used inhaler type10. By pushing down on the pressurised canister, an inert propellant gas along with a metered dose of medication is pushed out of the inhaler. Pressurised MDIs are generally recommended to be used together with a spacer for children under the age of eight and for people with poor dexterity7. Autohalers® on the other hand, are breath-activated MDIs and cannot be used with a spacer, as the medicine is sucked out from the device as the patient inhalers on the mouthpiece. Mist MDIs, also

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known as soft mist inhalers (e.g. Respimat®) are non-pressurised MDIs as they rely on a compressed spring to release the aerosol for inhalation. Mist MDIs do not rely on patient hand-breath coordination, inspiratory flow or the use of a spacer for effective drug delivery7. By definition a DPI device holds the drug in a dry powder form and is breath activated9. Accuhalers® and Turbuhalers® require the drug dose to be ‘loaded’ by sliding a thumb grip along a disc-shaped device (Accuhaler ®) or twisting the group on a cylinder-shaped device (Turbuhaler ®) before inhaling the medicine from the mouthpiece. Operation of the Ellipta® device requires a three step process; opening the mouthpiece cover, inhaling the dose via the mouthpiece, and then closing the mouthpiece cover 9. Other DPIs available contain the drug in a capsule form in a chamber within the device. To prepare the capsule for inhalation, a button is pushed or a mechanism is moved on the device in order to split open the capsule, releasing the drug to be inhaled via the mouthpiece. Varying examples of this form of DPI include; Aerolizer ®, Breezhaler ®, Genuair ®, HandiHaler ®, Rotahaler ® and Spinhaler ®3. Please refer to table 2 which summarises the current drug therapies available for the treatment of asthma or COPD via MDI or DPI devices.

Table 2 – DPI and MDI devices used in Asthma and COPD. DRUG CLASS

DRUG NAME

Short-acting Beta Agonist (SABA)

Salbutamol

Terbutaline

Eformoterol Long-acting Beta Agonist (LABA)

MDI/DPI

SINGLE DRUG BRAND/DEVICE*

Pressurised MDI

Ventolin® MDI

Breath activated MDI

Airomir ® Autoinhaler ®

Capsule DPI

Ventolin® Rotahaler ®

Dose loaded DPI

Bricanyl® Turbuhaler ®

Capsule DPI

Foradile® Aerolizer ®

COMBINATION FIXED DOSE BRAND/DEVICE

Budesonide: Symbicort® Rapihaler ® Fluticasone propionate: Flutiform® MDI

Pressurised MDI

Indacaterol

Dose loaded DPI

Oxis® Turbuhaler ®

Capsule DPI

Onbrez® Breezhaler ®

Dose loaded DPI

Serevent® Accuhaler ®

Budesonide: Symbicort® Turbuhaler ®

Fluticasone propionate: Seretide® Accuhaler ®

Salmeterol

Fluticasone propionate: Seretide® MDI

Pressurised MDI Short-acting muscarinic antogonist (SAMA) Long-acting muscarinic antogonist (LAMA)

Ipratropium

Pressurised MDI

Atrovent® MDI

Aclidinium

Capsule DPI

Bretaris® Genuair ®

Eformoterol: Brimica® Genuair ®

Glycopyrronium

Capsule DPI

Seebri® Breezhaler ®

Indacaterol: Ultibro® Breezhaler ®

Capsule DPI

Spiriva® HandiHaler ®

Mist MDI

Spiriva® Respimat®

Olodaterol: Spiolto® Respimat®

Dose loaded DPI

Incruse® Ellipta®

Vilanterol: Anoro® Ellipta®

Pressurised MDI

Qvar ® MDI

Breath activated MDI

Qvar ® Autohaler ®

Dose loaded DPI

Pulmicort® Turbuhaler ®

Tiotropium Umeclidinium Beclomethasone

Inhaled corticosteroids (ICS)

Budesonide

Pressurised MDI

Cicleoside

Pressurised MDI

Alvesco® MDI

Pressurised MDI

Flixotide® MDI

Fluticasone propionate Fluticasone furoate

Cromones

Cromoglycate

Nedocromil

Eformoterol: Symbicort® Turbuhaler ® Eformoterol: Symbicort® Rapihaler ®

Eformoterol: Flutiform® MDI

Dose loaded DPI

Salmeterol: Seretide® Accuhaler ®

Pressurised MDI

Salmeterol: Seretide® MDI

Dose loaded DPI

Vilanterol: Breo® Ellipta®

Pressurised MDI

Intal® MDI Intal Forte® MDI

Capsule DPI

Intal® Spincaps®

Pressurised MDI

Tilade® MDI

*Note other generic brands may be available

THE PHARMACIST’S ROLE Although the preferred method of drug delivery for asthma and COPD patients is via inhalation, of which inhalers are specifically designed to assist, approximately 90% of patients have incorrect inhaler technique when using either standard MDIs or DPIs12,13. Worsening asthma, increased use of relievers

and emergency medical services has been linked with the incorrect use of pressurised MDIs for ICS14. Additionally, inefficient inhaler technique for DPIs may also lead to insufficient drug delivery and lung deposition15. Doctors are cited to not have sufficient time to train patients regarding proper inhaler technique and therefore naturally

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this significant role should be played by the pharmacist13. For those patients who do show poor inhaler technique with a pressurised MDI, the addition of a large volume spacer or education from a health professional such as a pharmacist is suggested as the first line option (rather than simply changing inhalers)16.

BUSINESS 11 11 CONTINUING PROFESSIONAL DEVELOPMENT With significant advances in recent years to medication and drug delivery devices for asthma and COPD, pharmacists must stay abreast of changes and be prepared to check in with their patients on how their respiratory management is going. Note that this patient care should extend beyond the initial counselling given for a new medication, and be an ongoing service to offer patients in order to decrease the burden of the significant public health concerns that is asthma and COPD in the community.

ASSESSMENT QUESTIONS The assessment questions below can be found at the Guild Pharmacy Academy myCPD e-learning platform. Login or register at: www.mycpd.org.au

QUESTION 1 Which of the following statements is CORRECT? a. Both asthma and COPD are evidenced by coughing and wheezing, but asthma can only be diagnosed in childhood, whereas COPD is more likely to be diagnosed later in life b. Asthma is characterised by airway hypo-responsiveness, which leads to intermittent and usually reversible airway obstruction

REFERENCES: 1

Alshabanat A, Zafari Z, Albanyan O et al. Asthma and COPD Overlap Syndrome (ACOS): A Systematic Review and Meta Analysis. PLoS ONE. 2015 Sep 3;10(9):1-15. Asthma Australia. About Asthma [Internet]. 2016 [cited 2016 Nov 22]. Available from: https://www. asthmaaustralia.org.au Lung Foundation Australia. [Internet]. 2015 [cited 2016 Nov 22]. Available from: http:// lungfoundation.com.au/ Murphy, A. Knowing the differences between COPD and Asthma is vital to good practice. The Pharmaceutical Journal. 2011 Sep;287:399. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention [Internet]. 2015 Aug 11 [cited 2016 Nov 22]. Available from: http://ginasthma.org Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of COPD 2017 [Internet]. 2016 [cited 2016 Nov 22]. Available from: http://goldcopd.org Australian Medicines Handbook Pty Ltd. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook; 2016. Ejiofor S & Turner A. Pharmacotherapies for COPD. Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine. 2013;7:17-34. Grant AC, Walker R, Hamilton M et al. The Ellipta® Dry Powder Inhaler: Design, Functionality, In Vitro Dosing Performance and Critical Task Compliance by Patients and Caregivers. Journal of Aerosol Medicine and Pulmonary Drug Delivery. 2015;28(6):474-485. Yang I, Dabscheck E, George J et al. The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2016. Milton: Lung Foundation Australia; 2016 Oct. 171p. Version 2.47. National Prescribing Service. Pressurised metereddose inhalers for respiratory medicines [Internet]. 2016 [cited 2017 Nov 22]. Available from: http:// www.nps.org.au/ Ganguly A, Kumar Das A, Roy A et al. Study of Proper use of Inhalational Devices by Bronchial Asthma or COPD Patients Attending a Tertiary Care Hospital. Journal of Clinical and Diagnostic Research. 2014;8(10):4-7. DOI: 10.7860/ JCDR/2014/9457.4976. De Oliveira M, Bruno V, Ballini L et al. Evaluation of an educational program for asthma control in adults. J Asthma. 1997;34:395–403. McFadden E. Improper patient techniques with metered dose inhalers: clinical consequences and solutions to misuse. J Allergy Clin Immunol. 1995;96:278–83. Lotvall J. Inhalation therapy of the future–how will it change the way we treat asthma. J Aerosol Med. 2001;14(1):S45–50. Lavorini F, Magnan A, Dubus JC et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008;102:593–604.

c. The main cause of asthma is smoking, with approximately 50% of all smokers developing some form of airflow limitation d. COPD is characterised by progressive and irreversible airway obstruction e. Sputum production is a common clinical feature of both asthma and COPD

QUESTION 2 Which of the following statements in regards to treatment therapy for asthma in adults is INCORRECT? a. Tiotropium (Spiriva Respimat®) can be used as an adjunct in asthma maintenance treatment for adults b. Salbutamol used alone on a when required basis (less than two days per week) is sufficient for well-controlled asthma c. Salmeterol 50mcg can be used twice daily as a preventer, with salbutamol used on a when required basis as a reliever d. Theophylline has a limited place in asthma treatment due to its narrow therapeutic range and potential for toxicity e. Omalizumab is reserved for specialist prescribing in moderate to severe allergic asthma cases

QUESTION 3 Which of the following combinations of medications is NOT APPROPRIATE in the treatment management of COPD? a. SAMA alone b. SAMA + LABA c. SABA + LAMA d. SABA + LABA + LAMA e. SABA + LABA + ICS

QUESTION 4 Which of the following statements is INCORRECT? a. Some DPIs contain the drug in a capsule form b. Mist MDIs rely on a compressed spring to release the aerosol for inhalation, but still require a spacer for effective drug delivery c. Pressurised MDIs are recommended to be used together with a spacer for children under the age of eight d. By definition a DPI device holds the drug in a dry powder form and is breath activated e. Pressurised MDIs are currently still the most frequently used inhaler type

QUESTION 5 Which of the following statements is CORRECT? a. Autohalers® and Handihalers® are examples of DPIs b. Aerolizer ®, Breezhaler ® and Respimat® are all examples of capsule form DPIs c. Turbuhalers® require the drug dose to be ‘loaded’ by sliding a thumb grip along a disc-shaped device d. Genuiar ® is an example of a mist MDI e. Ellipta® and Rotahaler ® are examples of DPIs

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

BUSINESS

Creating Success from the Inside Out SEAN TUNNY Editor Gold Cross Products and Services Pty Ltd

JUDY CHEUNG Founder, Inventor SkinB5

SKINB5 IS A 100% AUSTRALIAN OWNED AND OPERATED BUSINESS, FOUNDED IN 2006 BY AUSTRALIAN ENTREPRENEUR, JUDY CHEUNG-WOOD. FIRST LAUNCHED AS AN ONLINE-ONLY BUSINESS, SKINB5 HAS SUCCESSFULLY ENTERED RETAIL AND DERMATOLOGY CHANNELS. THE NEXT EXCITING CHAPTER OF GROWTH HAS BEGUN AS SKINB5 ENTERS AUSTRALIAN PHARMACIES.

We recently spoke with Judy to gain a little insight into the company, the product and the pivotal role it is anticipated SkinB5 will play in pharmacy.

including those with severe conditions. At the end of 2016, SkinB5 formed partnerships with pharmaceutical wholesalers Sigma and Symbion to supply products to pharmacies across Australia.

EDITOR: SkinB5 is Australian owned and operated. Can you outline a little of the history and background of the company?

EDITOR: Medicated skin care is a very important category in a pharmacy setting that provides a natural fit with pharmacists’ service and advice. SkinB5 has a unique 4-step approach to acne treatment, what is this?

JUDY: In 2005, I met a former severe acne sufferer who successfully cleared his acne by taking a specific dose of Vitamin B5, following a medical hypothesis on the use of Vitamin B5 for acne which showed promising results. I then embarked on intensive research and started experimenting with a combination of reduced dose Vitamin B5 and other acne fighting nutrients supported by the best scientific evidence. After 3 months, my skin completely cleared and stopped breaking out. Soon after, SkinB5 was created and launched in 2006, supported by Austrade and seed capital from a prominent doctor from Tasmania. In 2007, we started small scale, exporting to Singapore (dermatology and retail) and the Philippines (dermatology), whilst selling to customers all over the world through our online platform. After receiving overwhelmingly positive feedback from users of SkinB5’s patented nutritional formulations, we gained the confidence to scale up the business for global growth in the dermatology and retail channels. We started exporting through distributors to South Korea in 2012, then in 2016 to China, the USA and the Middle East (dermatology). Since 2015, SkinB5’s presence in Australian pharmacies has grown organically through delivery of clear results to acne sufferers,

JUDY: SkinB5’s innovative (patented) natural acne treatment regime is suitable for all ages and skin types, and involves a simple 4-step system to treat and prevent acne from where it begins within the body. It works by stopping acne breakouts using powerful nutritional supplements in tablet form, supported by healing skincare products, all containing a potent dose of Vitamin B5 to effectively treat and prevent acne internally and topically. EDITOR: Why is it so important that the SkinB5 approach to treatment is followed? JUDY: Scientists have known for a long time that acne, like many other health conditions, is caused by underlying issues happening inside the body, and the active breakouts and infections on the surface of the skin are just symptoms. So to effectively treat acne, we must target the root causes, mainly overactive skin oil production, high stress levels, hormonal fluctuations and low immune systems. While our potent supplements address the root causes by providing key nutrients, the body needs to maintain healthy skin functions. Our gentle skincare products are designed to help the skin to heal and rebuild, and to

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

ORDER FORM

BUSINESS

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DISCOUNT: BUY 25 UNITS, GET 20% OFF SIGMA PDE

DESCRIPTION

SIZE

CTN Qty

MIN BUY

RRP

ORDER QTY

245845

SKINB5 Acne Control Extra Strength Tablets

180 Tabs

56.95

245852

SKINB5 Acne Control Caplets

90 Caps

44.95

245860

SKINB5 Acne Control Cleansing Mousse

245878

SKINB5 Acne Control Moisturiser

50ml

100

29.95

245894

SKINB5 Skin Purifying Mask

100ml

122

39.95

Proven to effectively treat & prevent 150ml 56 5 29.95 all types of acne & blemishes.

DISCOUNT: BUY 25 UNITS, GETSigma 20% OFFNo: Account

Pharmacy Name: Wholesaler

SIGMA PDE

DESCRIPTION Pharmacy restore its natural protective abilitiesAddress: against outside conditions e.g.

SIZE

245852

RRP

ORDER QTY

continue to use SkinB5. Customers trust pharmacists and pharmacy staff give them the and recommendations. Email: 180toTabs 32best treatment 5 options 56.95

bacteria, pollutants, weatherExtra etc. Strength Tablets 245845irritants, SKINB5 Acne Control Suburb:

SKINB5 Acne Control Caplets

EDITOR: SkinB5 is designed to work from the “inside out”. State: 245860 SKINB5 Acne Control Cleansing Mousse What is this approach?

Symbion Account MIN No: CTN Qty BUY Order Date:

Postcode:

Contact Name:

We have recently developed, with an industry expert, a Pharmacy 90 Caps Phone:24 5 44.95 Support Program for professional services pharmacies who want to Fax: offer150ml their customers to treat acne. 56an effective5alternative 29.95 Authorised Signature:

JUDY: The root cause Acne of acneControl lies within the body, so to treat and 245878 SKINB5 Moisturiser 50ml 100 5 29.95 EDITOR: Steering a company through suchTalk a diverse and02 competitive Trade Fax No. 8850 2226 prevent acne effectively, we must correct those underlying conditions market is quite a task, the highs and lows 245894 SKINB5 Skin Purifying 100ml 122how have you 5 managed 39.95 from the inside. On the outside, mostMask acne products focus on stripping Valid 01 January 2017 — 28 2017 of the journey so February far? oil and drying the skin, which often results in long-term damage to the skin’s natural protection mechanism. Therefore, whilst correcting the Pharmacy Name: Sigma Account No: JUDY: By keeping a firm eye on our vision, while calmly tackling root causes to stop acne, the skin needs external support to heal and challenges one at a time, strategically and confidently.@skinb5 We have#skinb5 Wholesaler Symbion Account No: rebuild its protective layer.www.skinb5.com developed a strong culture to expect the unexpected every day. We Pharmacy Address: believe there are always ways to get around obstacles — we just need Order Date: to be creative and think outside the box. EDITOR: In a pharmacy setting, how does professional advice Email: offered by a pharmacist compliment the SkinB5 offer? Everyone in our team LOVES the journey and we get enormous Suburb: Phone: JUDY: Acne sufferers search pharmacy shelves for OTC acne products pride and satisfaction from helping acne sufferers who often have then seek help from doctors and dermatologistsPostcode: who may prescribe given State: Fax:up all hope that there is a product which can help them. Forming oral and topical antibiotics, isotretinoin or hormonal treatments for strong partnerships with those who share our purpose has been most Contact Authorised Signature: girls. SkinB5Name: is an ideal product to present at the dispensary and the valuable through our journey. acne product section because it is a complementary medicine and a highly effective alternative option for patients who have to stop using Trade Talk Fax No. 02 8850 2226 EDITOR: For any pharmacist who would like to know a little more about prescription acne medication at some stage, or require a product that SkinB5, where should they look next? is more effective than topical creams.

Valid 01 January 2017 — 28 February 2017

Because SkinB5’s oral formulations are a new way to treat acne, education is essential. By having pharmacy staff explain SkinB5’s What, Why and How, it ensures customers get the best results and will

www.skinb5.com

JUDY: Visit www.skinb5.com or simply contact pharmacy@skinb5.com or call 1300 088 655. We will send out an information pack and product samples.

@skinb5 #skinb5

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

PRACTICE READY

Update for Pharmacists AARON D'SOUZA Pharmacist B.Pharm

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

SNAPSHOT

Adempas® [Riociguat] MF: Bayer Listed: 01 May 2017 Schedule 4: Prescription Only Medicine, S100: HSD Private1 11031N RIOCIGUAT, riociguat 500 microgram tablet, 42 (Adempas) 11058B RIOCIGUAT, riociguat 500 microgram tablet, 84 (Adempas) 11028K RIOCIGUAT, riociguat 1 mg tablet, 42 (Adempas) 11060D RIOCIGUAT, riociguat 1 mg tablet, 84 (Adempas) 11046J RIOCIGUAT, riociguat 1.5 mg tablet, 42 (Adempas) 11061E RIOCIGUAT, riociguat 1.5 mg tablet, 84 (Adempas) 11030M RIOCIGUAT, riociguat 2 mg tablet, 84 (Adempas) 11045H RIOCIGUAT, riociguat 2 mg tablet, 42 (Adempas) 11035T RIOCIGUAT, riociguat 2.5 mg tablet, 84 (Adempas) 11052Q RIOCIGUAT, riociguat 2.5 mg tablet, 42 (Adempas)

INDICATION

• •

DOSING

Pulmonary arterial hypertension (PAH); Chronic thromboembolic pulmonary hypertension (CTEPH)1.

DRUG CLASS Soluble Guanylate Cyclase Stimulators (sGC Stimulators)2. THERAPY GOAL Vasorelaxation, anti-proliferative and antifibrotic effects3. Increased exercise capacity and improved hemodynamic variables4.

ADEMPAS® [RIOCIGUAT]

Oral systemic dosing: Three times daily dosing (every 6–8 hours). If the patient takes antacids, they should be taken at least 1 hour after dose of Riociguat5. Missed dose: Take next dose as planned, do not double up. STORAGE AND HANDLING Ambient product: Store below 30oC6.

Pulmonary Arterial Hypertension (PAH) and Chronic thromboembolic pulmonary hypertension (CTEPH) are rare conditions requiring critical care7. The World Health Organisation classifies PAH into numerous subcategories8 – see Table 1. Broadly speaking, PAH takes place in the arteries and arterioles of the lungs9. CTEPH is characterised by obstruction of the pulmonary vasculature by a thrombi3.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

PRACTICE READY

TABLE 1: WHO PAH CLASSIFICATION GROUP

CLASSIFICATION

Pulmonary arterial hypertension (PAH) • Idiopathic (IPAH) • Heritable (HPAH): o Bone morphogenetic protein receptor type 2 (BMPR2) o Activin receptor-like kinase 1 gene (ALK1), endoglin (with or without haemorrhagic telangiectasia) o Unknown • Drug- and toxin-induced • Associated with (APAH): o Connective tissue diseases o Human immunodeficiency virus (HIV) infection o Portal hypertension o Congenital heart disease (CHD) o Schistosomiasis o Chronic haemolytic anaemia

Pulmonary veno-occlusive disease (PVOD) and/or pulmonary capillary haemangiomatosis (PCH)

Pulmonary hypertension due to left heart diseases • Systolic dysfunction • Diastolic dysfunction • Valvular disease

Pulmonary hypertension due to lung diseases and/or hypoxemia • Chronic obstructive pulmonary disease (COPD) • Interstitial lung disease (ILD) • Other pulmonary diseases with mixed restrictive and obstructive pattern • Sleep-disordered breathing • Alveolar hypoventilation disorders • Chronic exposure to high altitude • Developmental abnormalities

Chronic thromboembolic pulmonary hypertension (CTEPH)

PH with unclear multifactorial mechanisms • Haematological disorders: myeloproliferative disorders, splenectomy • Systemic disorders: sarcoidosis, pulmonary Langerhans cell histiocytosis, lymphangioleiomyomatosis, neurofibromatosis, vasculitis • Metabolic disorders: glycogen storage disease, Gaucher disease, thyroid disorders • Others: tumoral obstruction, fibrosing mediastinitis, chronic renal failure on dialysis

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

PRACTICE READY

For introductory videos on the Pathophysiology of Pulmonary Arterial Hypertension view:

https://youtu.be/9a4untSzLzg

https://youtu.be/SFbCh2wYSxQ

As Riociguat is reduced by 50–60%, patients are warned to stop smoking. Patients must ensure they monitor their blood pressure. Hypotension can occur anytime in therapy, especially during initiation. Dose titration should be considered. Bleeding risk must be ascertained prior to initiation. This is especially important for patients on anticoagulants.

PREGNANCY AND LACTATION5 Contraindicated. Pregnancy Category X. Cannot be used during lactation. Relevant to the mechanism of action of Riociguat is the “Nitric Oxide” pathway. In normal tissue, Nitric Oxide binds to Guanylate Cyclase stimulators leading to vasodilation3. See Figure 1 below. When there is impairment of nitric oxide synthesis and impairment of the signalling through the pathway, the pathogenesis of PAH occurs. Figure 1: Disease-Modifying Therapies Adapted from N Engl J Med 2004;351:1425-36

WHAT’S IN THE PACK? Amounts

21, 42, 84

Strengths

0.5mg, 1mg, 1.5mg, 2mg, 2.5mg

Tablets

Round, film-coated Bayer cross one side Second side:

Strength

Marking

Colour

0.5mg

0.5 R

White

1mg

Pale yellow

1.5mg

1.5 R

Yellow-orange

2mg

Pale orange

2.5mg

2.5 R

Red-orange

DOSING INFORMATION5

Riociguat works in two ways by: 1. Stimulating soluble Guanylate Cyclase (separate to Nitric Oxide); 2. Increasing existing soluble Guanylate Cyclase’s sensitivity to Nitric Oxide. Soluble Guanylate Cyclase is found in most tissues and is a receptor for Nitric Oxide5. The two mechanisms of action lead to an increase in the levels of cyclic GMP which causes vasodilation, antiproliferation of tissue and reduced fibrosis.

Oral systemic dosing: Three times daily dosing (every 6–8 hours). If the patient takes antacids, they should be taken at least 1 hour after dose of Riociguat5. Initiation: 1mg tds for 2 weeks. If patient does not tolerate possible hypotension, consider 0.5mg tds for 2 weeks. Increase dose every 2 weeks in 0.5mg intervals to a maximum of 2.5mg tds. If: Systolic BP

Signs/Symptoms

Dose Action

Broadly, Riociguat has been indicated for PAH and CTEPH.

≥95 mmHg

Hypotension

Decrease by 0.5mg tds

For PAH, it is used by itself or in combination with other agents for idiopathic, heritable, APAH-Connective tissue and APAH-Congenital Heart Disease. In CTEPH, it is indicated for persistent/recurrent and inoperable5.

<95 mmHg

–

Maintain dose

<95 mmHg

Hypotension

Decrease by 0.5mg tds

CLINICAL USE OF RIOCIGUAT

The treatment phases (Initial and Continuing) are dependent on a range of requirements1. It is prudent that for each PBS code listed on the prescription, the pharmacist reviews the PBS website and discusses with the patient their situation.

PRECAUTIONS & CONTRAINDICATIONS

Riociguat contraindications: •

Sensitivity to Riociguat;

•

Pregnancy and lactation;

•

Women of child-bearing potential who may become pregnant and are not using reliable contraception. Pregnancy must be avoided for 1 month prior to ceasing Riociguat;

•

Co-administration with Nitrates;

•

Co-administration with PDE-5 inhibitors and PDE inhibitors;

•

Pulmonary hypertension associated with idiopathic interstitial pneumonias (PH-IIP).

Establishing a maintenance dose for each patient is reliant on the signs and symptoms of hypotension. If the treatment must be ceased for more than 3 days, the dose should be restarted at 1mg tds for 2 weeks. Missed dose: Take next dose as planned, do not double up. Maximum daily dose: 7.5mg.

ADVERSE EFFECTS5,6

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

• • • • • • • • • • • •

Hypotension; Dizziness; Headache; Indigestion; Diarrhoea; Nausea; Vomiting; Swelling of extremities (hands, ankles or feet); Tiredness (may be due to decrease in red blood cells); Anaemia; Fast or irregular heart beats; Nosebleed;

PRACTICE READY

• • • • • •

Vasal congestion; Heartburn; Difficulty in swallowing; Constipation; Stomach pain; Stomach bloating.

Pharmacokinetics5,10 • • • • • • • • •

Bioavailability: 94%; Peak plasma time: 1.5 hr; Food does not affect bioavailability; Protein bound: 95%; Metabolised by CYP: 1A1, 3A4, 2C8, 2J2; 53% Direct Biliary/Faecal excretion (unchanged); 40% Renal excretion (unchanged); Half-life = 12 hrs (patients with PAH); 7 hrs (healthy individuals); Clearance: 1.8 L/hr (patients with PAH); 3.4 L/hr (healthy individuals).

DRUG INTERACTIONS Drugs contraindicated6,10 • • •

Nitrates; PDE-5 inhibitors; Non-specific PDE inhibitors: dipyridamole or theophylline.

Other interactions5,6 • • • • • • • • • • • •

Protease inhibitors; Ketoconazole, Itraconazole; Tyrosine kinase inhibitors; Cyclosporin; Epoprostenol; Antacids; Granisetron; Anti-epileptics: Phenytoin, Carbamazepine, Phenobarbitone; Anticoagulants; Anti-hypertensives; Clarithromycin; St John’s Wort.

REFERENCES: Australian Government Department of Health. Pharmaceutical Benefits Scheme (PBS) | Riociguat [Internet]. Australian Government Department of Health; [cited 2017 Feb 23]. Available from: http://www.pbs. gov.au/medicine/item/11031N. Makowski C, Rissmiller R, Bullington W. Riociguat: a novel new drug for treatment of pulmonary hypertension. [Internet]. [cited 2017 Feb 23]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26011143. 3 Ghofrani H et al. Riociguat for the Treatment of Chronic Thromboembolic Pulmonary Hypertension. N Engl J Med. 2013 Jul;369:319–29. 4 Ghofrani H et al. Riociguat for the Treatment of Pulmonary Arterial Hypertension. N Engl J Med. 2013 Jul;369:319–29. 5 Bayer. Riociguat Product Information [Internet]. [cited 2017 Feb 23]. Available from: https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2014-PI-016771&d=2017022316114622483. 6 Bayer. CMI Adempas [Internet]. Bayer; 2017 [cited 2017 Feb 24]. Available from: https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2014-CMI-01678-1. 7 Pulmonary Hypertension Association Australia. PHA Australia – Pulmonary Hypertension [Internet]. [cited 2017 Feb 23]. Available from: http://www.phaaustralia.com/page/2/what-is-ph. 8 Pulmonary Hypertension Association Australia. PHA Australia – Classification Of Pulmonary Hypertension [Internet]. Pulmonary Hypertension Association Australia. 2017 [cited 2017 Feb 23]. Available from: http://www.phaaustralia.com/page/11/classification-of-pulmonary-hypertension. 9 Lung Foundation of Australia. Pulmonary-Arterial-Hypertension-June-2014.pdf [Internet]. Pulmonary Arterial Hypertension. [cited 2017 Feb 23]. Available from: http://lungfoundation.com.au/wp-content/ uploads/2013/12/Pulmonary-Arterial-Hypertension-June-2014.pdf 10 Medscape. Adempas (riociguat) dosing, indications, interactions, adverse effects, and more [Internet]. Medscape Adempas. 2017 [cited 2017 Feb 23]. Available from: http://reference.medscape.com/drug/ adempas-riociguat-999863. 1

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HEALTH

Healthy Mama, Healthy Bub:

What you should be discussing with your customers WINNIE NGUYEN Training Coordinator B.Pharm.

HANDY FACTS • Daily folic acid supplementation should be at least 0.5 mg. • All women who are pregnant, breastfeeding or considering pregnancy should take an iodine supplement of 150 micrograms (μg) each day. • All women who are pregnant without complications should be encouraged to participate in at least 30 minutes a day or 150 minutes a week of moderate activity. • Encourage women to avoid drinking alcohol at any stage during pregnancy due to an increased risk of miscarriage. • All women who continue to smoke should be offered help to quit throughout the course of their pregnancy.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

HEALTH

PREGNANCY IS A TIME IN A WOMAN’S LIFE WHERE MAINTAINING GOOD NUTRITION AND WELLBEING IS EQUALLY IMPORTANT FOR BUB AS IT IS FOR THE MOTHER. NO MATTER HOW EXCITED A WOMAN MAY FEEL ABOUT THE PROSPECT OF A NEW ADDITION TO HER FAMILY, THE PREGNANCY ITSELF CAN AT TIMES BE BOTH EXHAUSTING AND OVERWHELMING, IN PARTICULAR, FOR NEW MUMMIES-TO-BE. WITH COMMUNITY PHARMACIES BECOMING READILY ACCESSIBLE TO INFORMATION AND PROFESSIONAL ADVICE, LET’S EXPLORE A FEW WAYS WE CAN ENHANCE OUR CONVERSATIONS WITH EXPECTING MOTHERS AND INFORM THEM ABOUT STAYING HEALTHY DURING THEIR PREGNANCY.

NOURISHING THE BODY Adequate nutrition and dietary supplementation during pregnancy represents a critical aspect of prenatal care. This is vital for not only supporting maternal needs, but also for providing the building blocks required for the development of a healthy foetus. Preventative health interventions such as folic acid and iodine supplementation are strongly recommended for all pregnant women and are considered public health interventions by the World Health Organisation (WHO). One of the most important conversations to have with your customer is ensuring she is receiving adequate folic acid supplementation. Folic acid is one of the B group vitamins, also known as B9. This vitamin plays an important role in preventing neural tube defects (NTD) such as Spina Bifida. In Australia, an estimated 600 pregnancies are affected by NTDs each year. Studies suggest that 50 to 70 per cent of these NTDs could be prevented if women of child-bearing age boost their levels of folate intake at least one month before conceiving, and in the first three months of pregnancy. Daily folic acid supplementation should be at least 0.5 mg. In addition to supplementation, dietary sources of folic acid include green, leafy vegetables, brown rice, granary bread and breakfast cereals fortified with folic acid. Always check the food labels! It’s important to note that it would be almost impossible to get enough folic acid just from food — the only way to be sure they are getting the right amount is by taking a supplement. While liver is very rich in folic acid, it is not safe to eat while pregnant or trying to fall pregnant. This is because liver is also very rich in vitamin A, too much of which can cause birth defects in babies. In pregnancy, the thyroid is particularly active, producing about 50% more thyroid hormones than usual. The thyroid uses iodine to produce hormones that assist in the normal development of the brain and nervous system before birth, in babies and young children. For this reason, it is necessary that pregnant and breastfeeding women receive appropriate iodine supplementation. The National Health and Medical Research Council (NHMRC) recommends that all women who are pregnant, breastfeeding or considering pregnancy take an iodine supplement of 150 micrograms (μg) each day. Beware of iodine supplements derived from kelp (seaweed) or kelp-based products because they contain varying levels of iodine and may

be contaminated with heavy metals such as mercury. For any women with pre-existing thyroid conditions, always refer them onto their medical practitioner if they are planning to start iodine supplementation.

the added benefit of alleviating some of the annoying discomforts that come along with pregnancy. Not all poses in yoga are suitable in pregnancy so make sure the instructors are well informed.

FINDING THE FITNESS GROOVE

MINDFUL MODIFICATIONS TO BAD HABITS

All women who are pregnant without complications should be encouraged to participate in at least 30 minutes a day or 150 minutes a week of moderate activity such as aerobic and strength-conditioning exercises as part of a fitness routine. Health gurus say that the best way for expecting mothers to keep up the momentum during the whirlwind months ahead is to lay the foundation for a solid exercise program. As a general rule of thumb, pregnant women can continue doing the same types of exercise they did before they were pregnant with a few exceptions and under supervision. Moderate intensity exercise is not only considered safe for pregnant women, it is encouraged and thought to benefit both mum and growing baby. Benefits include: •

Maintaining a healthy weight;

•

Preparing for the demands of labour and birth;

•

Improving physical and mental wellbeing;

•

Reducing the risk of developing gestational diabetes and hypertension;

•

Ensuring faster recovery post delivery.

While not all pregnancies will be without complications or risk, it is always important to ensure that before commencing a fitness routine, a medical assessment and tick of approval from a healthcare provider should be done. Moderate intensity aerobic exercises, such as walking, jogging and swimming, stimulate blood circulation and lungs as well as activate muscle and joint activity. This process helps the body utilise oxygen efficiently. Swimming in particular improves muscle tone and strength without impacting/ loading pressure on joints. Prenatal yoga has many proven benefits, from keeping joints limber and maintaining flexibility, to relaxation, lowering stress and managing blood pressure. It also has

Pregnancy is a window of opportunity for health professionals to help women make good lifestyle choices. It’s important to identify if your customer has a history of smoking, drug use, or alcohol consumption as they have all been linked to serious complications and risks for both mother and baby. Little is known about what is considered a ‘safe level’ of alcohol consumption during pregnancy and how it will affect the baby. The National Health and Medical Research Council strongly advises avoiding alcohol at any stage during pregnancy due to an increased risk of miscarriage. Other risk factors of excessive alcohol consumption include premature birth, low birth weight and impacts on the physical and mental development of the baby. Cessation of tobacco use, prevention of second-hand smoke exposure and prevention of relapsing to smoking are important and worthwhile goals to achieve during pregnancy. Women are motivated to protect their baby’s health, and quitting smoking during pregnancy reduces the risk of complications. Research shows that smoking cessation programs reduce the number of babies with low birth weight and preterm births. While quitting early in pregnancy produces the greatest benefits, reaffirm to customers that quitting at any time during pregnancy reduces the risk to the baby. All women who continue to smoke should be offered help to quit throughout the course of their pregnancy. Services such as the Quitline 13 78 48 or www.quitnow.gov.au are valuable resources women can use to seek support and guidance when deciding to quit. Smoking cessation goals must also be discussed with their general practitioner and midwife to ensure appropriate monitoring and support are provided.

REFERENCES: https://www.diabetesaustralia.com.au/news/11772?type=articles http://www.health.gov.au/internet/main/Publishing.nsf/Content/health-pubhlth-strateg-folate-index.htm http://www.pregnancybirthbaby.org.au/smoking-and-pregnancy https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/new45_statement.pdf

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Automation for Your Pharmacy MAKE THE RIGHT DECISION FOR YOUR BUSINESS ROBERT ALLEN CEO Dose Innovations

PHARMACY AUTOMATION HAS BEEN ON THE RISE IN RECENT YEARS WITH THE DECREASE IN PHARMACY MARGINS AND THE NEED FOR IMPROVED EFFICIENCY. AS AWARENESS AND POPULARITY REGARDING PHARMACY AUTOMATION HAVE INCREASED, THE NUMBER OF SUPPLIERS OF AUTOMATED MACHINES HAS ALSO GROWN IN THE MARKET.

Buying an automated pharmacy device is very different to buying a car. Expectations associated with a car typically include for it to take you from point A to point B safely. The prices and models of cars may differ, but the basic point remains: a car will get you from point A to point B. However, automation systems have very different functionality — some systems do not take you from point A to point B. Here are the key considerations when assessing the best Automation for your pharmacy.

AUTOMATION SYSTEM •

•

Channel Systems (also known as vending machines) o

Product must be scanned to identify the correct channel and manually filled

Have a specific channel for each product type

Are gravity fed, so need to be filled at a height above the exit point

Hold a limited volume of lines per channel, so need to be filled often

Shelf Systems (also known as chaotic systems)

within the dispensary may be required if the machine holds a smaller percentage of what your stock requirements are. It is important to understand that a low percentage of stock within the machine means a lower efficiency of the automated model. Also consider if your machine needs to store refrigerated items.

LOADING The loading mechanism of stock into the machine differs between models. By opting for a manual option of loading, the loading mechanism would still be much simpler as opposed to the currently used method. If opting for an automated model of loading, the percentage of stock holding capacity needs to be measured. Some machines check material during the loading phase, allowing a doublecheck to ensure correct dispensing.

DATA Stock on hand updates can now be fed into POS by some machines. Many important reports are now accessed by the machine to distinguish expired stock and also to manage held stock which helps PBS reform price reductions. Some machines come with an inbuilt OCR technology that reads expiry dates of dispensing products. The latest feature seen at APP was the ability of the machine to tick off the invoices of dispensing, saving considerable time and money by allowing paperless receipt of dispensing stock.

Products are scanned and placed into a single-entry point

Products are allocated to an available shelf space

No limit of the number of units per SKU

INTERFACING WITH YOUR DISPENSE AND POS SYSTEM

Hold a higher % of your stock items

The machine supplier needs to have command on the software of the machine to get the most out of it. While choosing a machine, conducting a market survey and talking to existing customers helps greatly to understand the machine system and its efficiency.

STORAGE The first and foremost question to be answered remains: Which products will be stored within the machine? Additional space

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RELIABILITY AND LONGEVITY Technology has a habit of changing and improving with time, rendering older models obsolete. You should always consider the support available for your machine, keeping in mind the resources you possess. It is advisable to put the following key points into consideration: Will the seller support your device and backup the promised warranty? If any issues do appear, will there be a technician available, skilled enough to diagnose and resolve the issue? Will the parts be available for your machine in a few years’ time? In basic terms, is the company you are purchasing the machine from going to be there for you in the future?

SUPPLIER/MANUFACTURER DIRECTION Australia is in the infancy of automation, and as such, it would be wise for an individual to seek out competitors and potential leaders of the market. Today for any machinery, the software plays an equally important role as the hardware, and to keep the device up to date, software development is the key. A company with a large global share will have the investment required to further develop your product and support it for many years to come. Many companies will provide cheap versions of automated machines — do not forget the price difference is there for a reason. Given that funding cost is at an alltime low, if you purchase a cheaper product that doesn’t do the job, it may cost you more in the long run. The fact is though, that interest rates will rise so there has never been a better time to lease equipment. When making this investment for your pharmacy it is imperative to research the market thoroughly, prioritise your wants and needs for automation and be sure to make an informed buying choice.

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You Need to Know How to Adapt Now for Profit (or Perish) PHILLIP A. CHAPMAN Director MiLease - New Rules of Leasing (Endorsed Lease and Management providers to the Australian Retailers Association & Pharmacy Guild of Australia, Members of Franchise Council of Australia)

A RECENT ARTICLE IN THE BRISBANE TIMES (BUSINESS PROPERTY) HEADLINED “SHOPPING CENTRES MUST CHANGE TO SURVIVE”, STATING THAT THE SAMENESS OF THE “COOKIE-CUTTER” APPROACH IS DYING.

However, the issues are more deep-seated than just looking at the property/retail precinct environment — retailing, or rather retailers, must adapt or perish. At the time of writing, 16 retail brands have disappeared over the past 12 months, with analysts predicting more to follow. Community Pharmacy is not immune to these cyclical and structural changes. In fact, the Pharmacy sector is under more pressure than any other retail category to transform. Pharmacy transformation is all about assessing and evaluating opportunity and information to develop a clear path to more successful retail business as well as introduce analysis tools to adapt to change. The only constant in the process is that “change is constant” and right now, community pharmacy is experiencing major changes across all facets of the business. Some of the challenges community Pharmacy is facing are: •

Government Intervention;

•

Corporatisation of Pharmacy;

•

Increased Competition;

•

Debt Covenants;

•

Omnichannel Healthcare.

Government Intervention will continue to put more pressure on all facets of the Healthcare industry as their appetite for cost savings maintains momentum. Add to this, the consumers’ (patients’) growing demand for high levels of service at

a low-end cost to them, and it is no wonder community pharmacy desperately needs to innovate and transform. The sector also needs to be far more agile to react and recover from “Blindside” interventions, such as Codeine up-scheduling, a major change in the core merchandising and delivery of over-thecounter medicines. Further, there is underlying uncertainty of the review into Pharmacy remuneration, and ownership and location rules, the outcome of which cannot be predicted. Corporatisation of Pharmacy (or at least the perception of) has been with us for over a decade, with the franchised business models, the wholesale branding models, and more recently the Terry White Chemmart merger (and likely IPO) and Ramsay Pharmacies’ foray into the sector, giving cause for serious reflection on what the sector will look like in another 10 years. In the past, decisions on which model to support were based on trading terms and catalogue/marketing reach. Pharmacists today need to consider and analyse more deeply such areas as market differentiation and pitch, demographic/ customer alliance, Franchisor/Buyer covenants and more. Within the next decade, will the sector also see the influx of overseas brands, such as Boots and Watsons, similar to the raid the retail fashion category has experienced in the

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past few years, resulting in over 50% of retail brand failures? Increased Competition is common across all retail sectors and you don’t have to look very hard to reflect on the retailer failures of only the past 12 months. The growth in competition is becoming almost exponential for specialty retailers and we are not talking about the constant bracket creep of the duopoly supermarkets, but the raid on personal care, health, and hair and beauty categories from the new or soon to arrive retail disruptors, like TK Maxx (formerly Trade Secret, with over 800 SKUs) and of course Amazon (with literally 1000’s of SKUs). Retail (Front of Shop Sales) is the area Pharmacy needs to focus on more than ever, but not the “cookie-cutter” approach which currently delivers a vanilla and bland offering. It must be reinvented if the categories of personal care, health, and hair and beauty are to remain relevant and strive within Pharmacy outlets. Debt Covenants, or more accurately described as “legacy debt”, in pharmacy are of concern. All too often the call comes in, “I owe more than my pharmacy is worth now – the Landlord needs to drop the rent.” Whether this debt is a hangover from the business purchase or is operational (fit outs/overdrafts), a conscious and structured program of debt reduction needs to be adopted to bring ratios under control. The return on investment equation is challenging and the application of capital

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and the amortisation of same within the lease cycle of Pharmacy must be addressed. Omnichannel Retailing is simply the morphing of bricks and mortar (traditional) retailing with digital retailing (online sales/ marketing). E-Commerce and traditional retailing need to be overlaid as a deliberate and meaningful offer and customer engagement strategy. Currently, either the digital realm is being ignored, or both physical and digital are being placed in silos, with digital only being thought of as a marketing tool (a replacement for catalogues). The customer experience starts in the home/workplace with their eyeballs on your digital real estate, and must be brought together with sightlines on your shopfront/ shelves to integrate both physical and digital real estate. These change challenges need to be understood and, where applicable, integrated into your pharmacy transformation to meet the future needs of the community and to

deliver sound returns. But all transformation strategies in the world will come undone if the foundations of your business are not sound.

And that is why, in conjunction with Goldcross and ITK, a Webinar especially on the topic of retail leasing, New Rules of Leasing, will be held on 20 April for Pharmacy only.

The location and, more specifically, your retail shop lease need to also be reviewed, measured and analysed to ensure the future security of the business with commercial outcomes that set you up to implement your transformation strategies.

In this session you will learn about: •

Critical Path of Lease;

•

Measuring Real Estate performance;

•

Lease mapping;

•

Research techniques + tools;

This is a specialised area of expertise and it is difficult sometimes to access the measures and tools to be effective in lease negotiation.

•

Creating + Capturing value (Business assets);

•

Action steps to a better lease;

•

New Rules of Leasing program;

Although Lease1 provides advice and assistance to 100’s of Pharmacies every year, along with the high number of leases negotiated each year to reduce commercial terms, we cannot gain enough traction across the sector, so more needs to be done and it needs to be done now. Pharmacists need to be coached in the tools and skills to achieve better commercial outcomes themselves, the New Rules of Leasing.

•

Much more!

All Pharmacists that register for this topical and timely Webinar will receive a FREE copy of our eBook, Retail Lease Definitions, as a useful reference book for their current and future lease negotiations. For more information and Webinar Registration details, see the advert in this edition.

"Pharmacy transformation is all about assessing and evaluating opportunity and information to develop a clear path to more successful retail business as well as introduce analysis tools to adapt to change."

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What motivates you? Why are you in business?

How do you measure success?

How do these objectives differ from those of being a pharmacist?

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Financial Metrics and the Pharmacy Market FRANK SIRIANNI Management Consultant MEDICI CAPITAL www.medici.com.au

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

THE ULTIMATE BUSINESS GOAL IS TO CREATE WEALTH. IT IS NOT JUST ABOUT SALES OR PROFIT, BUT ALSO THE CAPITAL COSTS AND RISKS ASSOCIATED WITH THE BUSINESS. IN THE LONG TERM, PROFIT MAY DRIVE WEALTH, BUT TO MANAGE AND SUSTAIN WEALTH YOU NEED TO MANAGE BOTH RISK AND CAPITAL COSTS.

WHAT DETERMINES FINANCIAL PERFORMANCE?

EBITDA

The key focus of this article is financial.

Earnings Before Interest, Taxes, Depreciation, and Amortisation (EBITDA) is based on Profit, but the following items are “added back”:

I understand that for many owners, it’s not just about the money! Other factors may include, contribution to the community and world; creating a fulfilling workplace for you and your team; and lifestyle. However, without good financial outcomes, these other and nonfinancial objectives cannot be achieved.

EBITDA, like Profit, excludes capital costs (i.e. Refits and Loan Repayments).

For many financial analysts, the key measure of success is profit. There are two accounting definitions of profit: 1. Earnings Before Interest, Taxes, Depreciation, and Amortisation (EBITDA) equals sales revenue, minus cost of goods sold and all expenses, except for interest, amortisation, depreciation and taxes.

Profit, however defined, is very difficult to measure and often very tough to use as a management tool. Profit is often not measured until after the completion of the reporting period. For many pharmacy owners, it is left as long as possible as the next step is the tax return!

•• S ales; •• L ess Cost of Goods Sold; •• Less Expenses, including: Wages; Rent; Depreciation; Interest;

Other expenses.

Equals Profit (from an accounting perspective).

WHAT DRIVES PHARMACY VALUE AND WEALTH CREATION? Two factors drive pharmacy value and wealth creation: 1. Net Cash Flow after allowing for capital requirements of owning and operating a pharmacy.

2. Profit, in simpler terms, is generally defined as sales, minus all expenses incurred to generate those sales.

Profit (from your Profit & Loss Statement) equals:

And, as with Profit, it is before Taxes. In other words, Profit before accounting for the above expenses.

WHAT IS PROFIT?

Profit

•• I nterest; •• Amortisation; •• Depreciation.

2. The risks associated with the pharmacy, including operations, location, financial, and general market conditions. Both of these need to be managed. It is not just about the cash flow (after taking account of capital requirements), but also about managing risks and developing a desirable pharmacy.

LET’S LOOK AT THE AUSTRALIAN PHARMACY DATA FOR THE LAST 5 YEARS Best practice is a technique or methodology that, through experience and research, has been proven to reliably lead to a desired result; in other words, more efficient businesses achieving consistent results and/or the best outcomes when compared to similar or average pharmacies. Pharmacy performance varies by Shop size, Trading hours, Business model, and Location. Many pharmacy owners and managers are well aware of this and will often comment on this by saying, “My pharmacy is different because …” These factors, which you believe GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

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are differences for your pharmacy, are often the drivers of business performance. For the purpose of this article, I have kept the analysis simple: understand your specific model and compare like with like. Averages are not relevant and generally not representative as they are skewed by a few very large businesses, pushing the mathematical average up. For example, based upon our data, the average pharmacy annual sales for the 2015/16 financial year were approximately $3.62 million. However, the median (50% point in the distribution) was closer to $2.94 million.

PHARMACY FINANCIAL MANAGEMENT – BACK TO BASICS When examining pharmacies, 3 key expenses explain approximately 90% of the expenses for most pharmacies. They are: 1. Cost of Goods Sold; 2. Salaries and Wages (including owners’); 3. Rent and Outgoings. And they are generally in that order. However, in some locations, pharmacies pay their landlords more than they do their staff.

Gross Profit Gross Profit represents Annual Sales, less Cost of Goods Sold. Pharmacy owners and managers often prefer to focus on Gross Profit as a key financial metric. While the expectation was that total Gross Profit would decline due to PBS Reforms, the data indicates material decline from 2013 through to 2015, with an increase in 2016. Nevertheless, the 2016 levels remain slightly below the 2012 levels. I suggest that Gross Profit is a critical measure as it represents the true trading income of a pharmacy. For many pharmacy owners, this is the key measure of financial health which drives the ability to pay staff, expenses, and create wealth.

The total wages for the last 5 financial years suggests a slight increase in wages over that time. While the change is not material, wages have remained relatively stable.

Rent and Outgoings Rent & Outgoings is generally the third highest expense for most pharmacies, although sometimes pharmacies located in major regional shopping centres and medical centres pay more to the landlord than they do their staff. Many pharmacies operate under leases with fixed escalation clauses (i.e. rent increases of say 3 to 5% per annum) when annual sales and gross profit have respectively been declining or flat. If rent is becoming a major problem for your pharmacy, you will urgently need to consider the suitability of your location for your current business offer.

Pharmacy Valuations As a general economic principle, if a market is well-informed and unbiased, then market price and value are the same. An efficient and active market will trade so that the market price approaches the economic value of the asset being traded. The share, bond, and property markets are examples of efficient and active markets. These markets have a large number of transactions and they have many stakeholders actively engaged in the market to ensure price moves to reflect value. The market for the sale of pharmacy businesses is not an efficient and active market. With less than a few hundred transactions per annum, the market volume is not efficient and active. Ultimately the value for a pharmacy rests with future benefits and the value, in current dollar terms, of expected future returns1.

Pharmacy Valuation Formula Pharmacies generally sell on a “Capitalisation of future maintainable earnings” approach using the following formula:

Salaries and Wages (including owners’)

Pharmacy Value =

Salaries and Wages (including the owners’ salaries where they work as pharmacists in the business) is generally the second highest expense for most pharmacies.

FME (or Adjusted Net Profit) Capitalisation Rate

For example $2,000,000 =

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$400,000 (20%)

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Where: •

•

FME (Future Maintainable Earnings) is generally calculated using the most recent Adjusted Net Profit adjusted for valuation purposes to identify the likely sustainable income to an owner with average business competency. Capitalisation Rate represents the relevant and required yield on the pharmacy to reflect risk and the qualitative aspects of the pharmacy.

The formula and approach assumes that the recent Adjusted Net Profit will remain constant (i.e. no growth or decline) for the foreseeable future and is a reasonable measure of the Future Maintainable Earnings for the pharmacy. The formula and approach also assumes that the capitalisation rate will remain applicable for this pharmacy into the foreseeable future. Given the recent history for pharmacy and expected outlook, these assumptions are clearly unrealistic.

DRIVING YOUR PHARMACY VALUE POST — PBS REFORMS To maintain or improve pharmacy value post-PBS Reforms requires you to focus on the two elements or drivers of value:

items sold. The impact will vary depending on the focus of your pharmacy. In light of this, understanding your business and developing a long-term strategy are critical to your business and financial survival. Clearly, a critical issue is to understand what business you are in and set your long-term plans accordingly. As a final comment, you will also need to consider the viability of your pharmacy, taking account of the capital costs of your pharmacy — these have increased substantially in recent years. You will also need to take note of the impact of PBS Reforms on your pharmacy and the current economic environment, to build an appropriate road map for your pharmacy. It is our belief that good operators who take action will survive and do well in the foreseeable future. If you have any questions about this article or pharmacy business issues, please call or email our team at any time.

WHAT ARE YOUR IDEAS? Tell us your story. What are your ideas? How are you building your new road map for your pharmacy in the light of recent challenges? Tell us some success stories. Let’s discuss — email me or call.

1. Return or cash flow; 2. Risk.

Please call Medici Capital on (03) 9853 7933 for further information or to discuss the results.

To improve return or “future” maintainable income, you will need to work on sources of income and address business performance issues. Strategies may include the diversification of income sources and stability of income.

The following provides a summary of the websites where more information can be obtained: MEDICI CAPITAL – CORPORATE WEBSITE www.medici.com.au

Risk is a more complex issue for many pharmacy owners. Strategies to manage risk may include measures to improve the quality of “future” maintainable income and diversification of sources of income. Security of tenure (lease) and reliability of income sources may also assist.

PRACTICE4SALE – LISTING SERVICE FOR PHARMACY SALES www.practice4sale.com.au JOBS4CAREERS – LISTING SERVICE FOR PHARMACY JOBS www.jobs4careers.com.au

Measures of risk for pharmacy, include assessment of the stability, desirability, and quality of income.

ATTAIN – BUSINESS BROKERS AND PROPERTY SALES www.iattain.com.au

Conclusions The nature of pharmacy is changing. PBS Reforms and Price Disclosure will inevitably result in the reduction in gross profit margins for PBS

REFERENCE: Net Present Value model (NPV) is the logic underpinning all business valuations.

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NAPSA’s Role in Creating Tomorrow’s Pharmacists

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SHEFALI PAREKH National President NAPSA

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

THE NATIONAL AUSTRALIAN PHARMACY STUDENTS’ ASSOCIATION (NAPSA) IS THE PEAK PHARMACY STUDENT BODY IN AUSTRALIA, RUN BY A STUDENT BOARD FOR ALL PHARMACY STUDENTS ACROSS 18 UNIVERSITIES. OUR PURPOSE IS TO ADVOCATE, EDUCATE, CONNECT AND INFORM.

NAPSA wants to make sure students are job-ready and excel in their pharmacy career, which is why we offer our members complementary access to an online education suite, MyNAPSA. Currently, MyNAPSA acts as a supplementary resource to the University curriculum for pharmacy and features a number of services. The education modules increase the pharmacy and product knowledge of our members. In addition to online education, we offer a number of face to-face education opportunities in the form of branch-level lectures and workshops for our members, including first aid, wound care and infant nutrition.

not undertaken a rural placement. Although 57% of participants believed their greatest barrier to working in a non-metropolitan area is the distance from family and friends, 65% of those who had completed a rural placement disagreed that their placement was negatively affected by location issues. This proves that experiencing rural pharmacy during a university placement has the ability to change students' perceptions of where they are capable of expanding their practice in the future. As a result, NAPSA boasts an interactive map which allows students to visualise the locations of rural or remote pharmacies across Australia.

care setting in every student's third or fourth year of their Pharmacy degree.

Last year, over 750 members took time to respond to NAPSA's National Pharmacy Student Survey (NPSS) where 85% agreed that community pharmacy employment while studying is important, but only 68% of students confirmed they are currently employed in a community pharmacy capacity. For this reason, NAPSA has commissioned a Jobs Board called Leep which promotes both intern and student positions.

NAPSA prides itself on being able to present the unique and invaluable student voice to the industry on common industry issues. It was very clear in the 2016 NPSS that the pharmacy students of Australia wanted more hospital pharmacy exposure throughout their degrees, with 44% of students wanting a career in hospital pharmacy, but only 7% feeling fully prepared to apply. NAPSA and the Society of Hospital Pharmacists of Australia (SHPA) released a joint position statement addressing our concerns on the matter, highlighting the need for each Australian university to include, at minimum, a compulsory three-week placement in an acute

NAPSA has also been involved in industry conversations around pharmacy remuneration and regulation, and the Advanced Practice framework. In regards to workforce issues, students identify one of the greatest barriers to them as a future pharmacist as being poor salary. As a result, NAPSA submitted a response to the King Review. NAPSA responded to the conclusion of the Advanced Practice program pilot by submitting a position statement to the Pharmacy Practitioner Development Committee which highlighted some resolutions for them to consider. We will continue to advocate for pharmacy students in this way.

NAPSA strives to advocate and encourage students to experience rural pharmacy whilst in university. 42% of NPSS participants were interested in rural or regional pharmacy for their internship year, yet 71% of students had

NPSS also indicated mental health as an area of education students would like to see a heavier focus on from NAPSA, with 73% of respondents indicating that Mental Health First Aid training should be a requirement of the Pharmacy Board of Australia (PBA) to become a Registered Pharmacist. It is this widespread consensus that led NAPSA to release a position statement on R U OK? Day last year to lobby for this qualification requirement to be set by the PBA.

“NPSS indicated mental health as an area of education students would like to see a heavier focus on from NAPSA, with 73% of respondents indicating that Mental Health First Aid training should be a requirement of the Pharmacy Board of Australia (PBA) to become a Registered Pharmacist.”

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CONTINUING PROFESSIONAL DEVELOPMENT

Smartphone ownership in Australia has increased from

11.1 million in 2013 to

15.3 million mid-way through 2015

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CONTINUING PROFESSIONAL DEVELOPMENT

Digital Transformation in an Ageing Demographic Landscape DANNY AGNOLA B.Pharm James Cook University Member of the Australian College of Pharmacy

Learning Objectives: After reading this article, the learner should be able to: • Understand how new technology can help control growing healthcare costs. • Recognise the functions a smartphone app can have to improve patient medication adherence. • Understand the limitations pharmacists have when interpreting data from smartphone apps and other wearable technology. • Understand the benefits of 3D printed dosage forms. • Recognise the methods digital marketing can be used to improve your business.

Competencies Standards Addressed: 1.3, 3.4, 6.2, 6.3, 7.2. Accreditation Number: G2017005 This activity has been accredited for 1 hour of Group 1 CPD (or 1 CPD credits) suitable for inclusion in an individual pharmacist’s CPD plan which can be converted to 1 hour of Group 2 CPD (or 2 CPD credits) upon successful completion of relevant assessment activities.

WITH AUSTRALIA’S EVER-INCREASING AGEING POPULATION, THE FOCUS OF THE BROADER HEALTHCARE SYSTEM INCLUDING COMMUNITY PHARMACY WILL NEED TO SHIFT FROM A ‘REACTIVE’ OR TREATMENT BASED APPROACH TO A MORE COMPLEX VIEW AROUND CONSUMER HEALTH PREVENTION, WITH SPECIAL REGARDS TO CHRONIC DISEASE STATE MANAGEMENT.

Australia’s healthcare system is facing tremendous challenges driven by increasing costs, increasing demand and improvements in addressing complex, previously untreatable conditions. Health promotion and prevention will be integral to services provided in pharmacies in the future. The adoption of digital services and new technology will hugely assist this process. According to the Futurist, Gihan Perera, speaking at the Pharmacy Connect Conference 2016, our world is ‘fast, flat and free’: -

Fast – change is happening faster than ever before;

Flat – we are breaking down hierarchies and control;

Free – prices are coming down and competition is going up1.

It would be easy to discuss digital technology and pharmacy in relation to familiar items such as online ordering, eRx, electronic health records and even telehealth. But what if we were to look even a few years into the future? How would you future-proof your business, taking into account the ageing population and the chronic disease and preventative health sectors?

MEDICATION ADHERENCE Poor adherence with medication regimes can have multiple negative effects on a patient’s quality of life, effectiveness of a particular treatment and possible unnecessary escalation of therapy. These effects are not only detrimental to the patient, but to the Australian healthcare system as a whole, with the inappropriate use of medications costing the public

hospital system around $380 million per year2. Smartphone ownership in Australia has increased from 11.1 million in 2013 to 15.3 million mid-way through 20153. Medication apps, therefore, represent a possible strategy that pharmacists can recommend to their customers, especially those who are non-adherent to regular medications. SMS-reminder services have had a place in community pharmacy for several years with variable results. The future medication apps (and some of these functions are available today) will include: -

An automatically updated medication list which advises: o

The patient/carer: what their medications are, assistance in complex tapering regimes, alerts and quantities left;

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CONTINUING PROFESSIONAL DEVELOPMENT

The pharmacist: to fill a repeat or new prescription, or automated dispensing;

The doctor: alerts when last repeat has been filled and appointment scheduling.

Comprehensive Consumer Medication Information which prevents unnecessary access to ‘Dr Google,’ but could also provide 24-hour access to a pharmacist or doctor;

In-app health promotion where patients are able to discover how best to manage their condition;

Delivery of medications for housebound or nursing home patients;

Multilingual options for a culturally diverse population4.

What about the use of nanotechnology? With this industry progressing so quickly, scientists have developed technology which is able to track if/when a patient takes their medication, and will send them an alert if they are not adhering to their medication regime. This is achieved by nanoparticles which are consumed by the patient in pill form, analysing stomach contents to determine if a certain medication has been taken. In the future, an app using this technology could not only alert the patient, but also the patient’s pharmacist and doctor to ensure adherence.

"Pharmacists are an accessible and trusted health professional, and we will be asked in the future (if not already) to interpret results from medical smartphone apps." MedsCheck? Access to ReadyCare if the need arises? What about associated costs for the new service? All these questions would need to be answered in due time.

ADVANCES IN WEARABLE, SMARTPHONE AND POINT-OF-CARE TECHNOLOGY

Pharmacists are an accessible and trusted health professional, and we will be asked in the future (if not already) to interpret results from medical smartphone apps. Although we are not there to necessarily diagnose conditions, it will be in our scope of practice to offer support and education to the patient, and offer timely referral to a doctor if the need arises. Smartphone apps and other associated technology have been shown to be surprisingly accurate. Two separate studies have shown this accuracy with the smartphone’s camera function acting as an electrocardiogram in one6, and controlled measurements from pedometer apps in another7. Interpreting the results from wearable medical devices or smartphone apps could be a new professional service in a pharmacy of the future. Could we make it part of a

In 2015, the USA Food and Drug Administration (FDA) gave approval to the first 3D printed medication11. This is just the start of an exciting future for 3D printed medications, including: -

Personalised drug dosing: patients who take a number of regular medications or use medications with narrow therapeutic indices could benefit from personalised 3D printed drugs. Pharmacists could analyse a patient’s pharmacogenetic profile as well as other characteristics such as age, weight and body fat percentage to determine optimal medication dose. 3D printing could also enable patients on multiple medications to be dosed in a single tablet, potentially improving compliance11.

Unique dosage forms: the different types of materials used in 3D printing offers the ability to create limitless dosage forms. From the FDA-approved levetiracetam tablets which dissolve immediately in the mouth, to a range of controlled-release formulations12.

Complex drug-release profiles: the creation of medications with complex drug-release profiles is one of the most researched uses for 3D printing13. 3D printers can create a standard controlledrelease formulation, or they could also be formulated in complex geometries that are porous and loaded with multiple drugs throughout, surrounded by barrier layers that modulate release. 3D printing is not only proven effective in oral dosage forms, but in implantable drug delivery devices too, reducing the amount of drug needed, and therefore decreasing the chances of systemic side effects11.

So what sort of apps and devices could pharmacists be asked to interpret in the future? There is a steady stream of exciting medical apps and devices coming to market, including: -

WEARABLE TECHNOLOGY Many Australians now pair their smartphone with wearable technology. More than half of us sport a wearable device and health is given as the number one reason we buy them5. These devices put a patient’s real-time personal health data in their own hands. With these devices measuring blood pressure, heart rate, blood glucose, sleep cycles etc, how comfortable are you at interpreting all this endless data? Also, how can a pharmacist be confident in the accuracy of the information?

3D PRINTING

In-pharmacy point-of-care testing for group A streptococcal pharyngitis. A recent pilot study in the United Kingdom found that patients initially screened for a sore throat, were offered a throat swap for Streptococcus pyogenes. Those who received a positive test were offered antibiotic treatment. Australian community pharmacists don’t have the ability to prescribe antibiotics, but it could help prevent unnecessary GP and emergency department visits, as well as decrease the growing antibiotic resistance trend8.

There are several different electrocardiogram apps on the market, and although their accuracy has been proven to be good, it does not eliminate the need to see a GP. They are a combined device and app, and work by converting electrical impulses from the finger tips or chest, into an ultrasound signal which is transmitted directly to a smartphone’s microphone. This then displays the reading on the smartphone’s screen9.

Fans of Star Trek will be aware of the Tricorder, a multifunction handheld device used for sensor scanning, data analysis and recording data. It seems that medical tricorders are closer to reality than what we may think. In 2011, a Tricorder XPrize was announced. A US$10 million incentive to develop a mobile device that can diagnose patients as well or better than a panel of doctors has been proposed. These devices will be expected to accurately diagnose 13 health conditions from sleep apnoea and urinary tract infections to vital signs such as blood pressure and respiratory rate. The winner of this prize is expected to be announced in 201710.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

3D printing will require vision, money and time for the technology to evolve into the anticipated applications described above11. Although we are not likely to see 3D printers churning out medications for patients in our community pharmacies within the next few years, it does provide a look into an exciting future for drug delivery.

DIGITAL MARKETING Many pharmacies are overwhelmed by the thought of going digital, and miss out on the opportunity of leveraging social media. And

CONTINUING PROFESSIONAL DEVELOPMENT

when they do market themselves online, many fail to engage the customer. Pharmacists are a trusted source of information and professional assistance, and need to reinforce this standing online as well as they do offline. So instead of inundating your website or Facebook page with sales and promotions, connecting with your customers on a personal or community level will help promote your pharmacy, as well as reach out to new customers14. Concentrate on in-store promotions, congratulate the local sports team with their latest win, put community REFERENCES: Perera, Gihan. Are you fit for the future? (2016) Presentation. Pharmacy Connect Conference, Sydney. 2 Australian Department of Health & Ageing. Evaluation of the DAA/PMP Programs. (2010) PriceWaterhouseCoopers, Australia. 3 Wang, Yuan. Yump. 2016 Australian Mobile Statistics: How digital is increasingly a mobile first experience. (Accessed online January 2017) https://yump.com.au/2016-australian-mobilestatistics-how-digital-is-increasingly-a-mobile-firstexperience/ 4 Dayer L, Heldenbrand S, Anderson P, Gubbins PO, Martin BC. Smartphone medication adherence apps: Potential benefits to patients and providers. Journal of the American Pharmacists Association : JAPhA. 2013;53(2):172-181. doi:10.1331/ JAPhA.2013.12202. 5 PriceWaterhouseCoopers. Report: Rapid adoption of wearables, 2016. (Accessed online January 2017) https://www.digitalpulse.pwc.com.au/2016wearable-statistics-report/ 6 Chan, Pak-Hei et al. Diagnostic performance of a smartphone-based photoplethysmographic application for atrial fibrillation screening in a primary care setting. Journal of the American Heart Association. 2016;5:e003428. 7 Case MA, Burwick HA, Volpp KG, Patel MS. Accuracy of Smartphone Applications and Wearable Devices for Tracking Physical Activity Data. JAMA. 2015;313(6):625-626. doi:10.1001/ jama.2014.17841. 8 Thornley, T. et al. A feasibility service evaluation of screening and treatment of group A streptococcal pharyngitis in community pharmacies. J Antimicrob Chemother 2016; 71: 3293–3299. 9 Alive Technologies. Alivecor Kardia Mobile ECG. (Accessed online January 2017) http://www.alivetec. com/ 10 QualComm. Tricorder XPrize. (Accessed online January 2017) http://tricorder.xprize.org/ 11 Ventola CL. Medical Applications for 3D Printing: Current and Projected Uses. Pharmacy and Therapeutics. 2014;39(10):704-711. 12 Aprecia Pharmaceuticals. First FDA-Approved Medicine Manufactured Using 3D Printing Technology Now Available. (Accessed online January 2017) https://www.aprecia.com/pdf/ ApreciaSPRITAMLaunchPressRelease__FINAL.PDF 13 Ursan I, Chiu L, Pierce A. Three-dimensional drug printing: a structured review. J Am Pharm Assoc. 2013;53(2):136–144. 14 DeBenedette, Valerie. Social media and pharmacy: 6 tips on best practices. (Accessed online January 2017) http://drugtopics.modernmedicine.com/ drug-topics/content/modernmedicine/modernmedicine-feature-articles/social-media-andpharmacy-6-tips?utm_source=TrendMD&utm_ medium=cpc&utm_campaign=Drug_Topics_ TrendMD_0 15 Pharmacy Board of Australia. Social Media Policy. (Accessed online January 2017) http://www. pharmacyboard.gov.au/Codes-Guidelines/Socialmedia-policy.aspx 1

photos on your webpage or become a onestop-shop for health tips, customer surveys (that can be used to improve your business) and other useful information that will make your pharmacy appear to be a community hub. (Pharmacists should refer to the Pharmacy Board Social Media Policy15 to be reminded of what is and what isn’t suitable to be posted on that medium).

CONCLUSION Automation and the growing digital age will change the role of the community pharmacy

over the next five to ten years. This emerging trend will allow pharmacists and pharmacy staff to increase their focus on patient care and disease-state management services such as diabetes and vaccinations, leading to greater patient loyalty and a more profitable business. With the role of community pharmacy ever-changing in the digital age, it is important for pharmacists to keep up-to-date with new technology and remain open to new ideas. In the words of Gihan Perera, ‘are you fit for the future?’1.

ASSESSMENT QUESTIONS The assessment questions below can be found at the Guild Pharmacy Academy myCPD e-learning platform. Login or register at: www.mycpd.org.au

QUESTION 1 The use of digital technology has the ability to decrease Australian healthcare spending. How much does the inappropriate use of medications cost the Australian public hospital system each year? a. $280 million. b. $38 million. c. $830 million. d. $380 million.

QUESTION 2 Which of the following would NOT be a function of an ideal medication app for the improvement of a patient’s medication adherence? a. Up-to-date consumer medication information on the medication as well as illness it is treating. b. Patient assistance in complex drug tapering regimes. c. One profile per app, so families or carers could not manage the medications of loved ones. d. A tick-box for delivery of medication to housebound customers.

QUESTION 3 A customer has used a smartphone app to measure their heart rhythm, and would like you to interpret the results. Which of the following would be the LEAST appropriate action for you to take? a. Refer to the doctor for professional advice. b. Tell the patient that it looks fine and they have nothing to worry about. c. Provide leaflets and other resources for the patient, and if they are concerned about the results to contact their doctor. d. Tell them that is not in the scope of your role as a pharmacist to interpret the results of the app, but you can provide a MedsCheck to discuss any medications they might be taking.

QUESTION 4 Which of the following is NOT a benefit of 3D printing medications? a. Present day cost-effectiveness. b. Individualised drug dosing for patients. c. Complex drug release profiles. d. Unique dosage forms.

QUESTION 5 Which of the following would be the most effective way of engaging your customers via social media? a. Advertising that your pharmacy will price match any competitor’s pricing. b. Attending a community event and posting pictures of the event on your pharmacy’s Facebook page. c. Leaflet mail drops advising customers of your pharmacy’s Facebook page. d. Promotion of an instore vitamin sale.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

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HEALTH

KARINA SAVAGE Director Smartbite Nutrition Counsulting

Karina is a leading Paediatric Dietitian from Smartbite Nutrition Consulting. She specialises in gut issues such as food allergy, intolerance and colic. Being a mum herself, she loves helping parents manage tricky little tummies. She presents regularly to both parents and health professionals. Being a leader in her field, Karina also works with media, providing expert comment both in print and on screen. She has great resources and information on her website www.smartbite.com.au.

"Probiotics are known as the non-pathogenic bacteria which can benefit a host by positively altering the microflora through implantation or colonisation."

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

HEALTH

The Role of

PROBIOTICS

in Infants and Children with Diarrhoea

THE HUMAN GUT

ANTIBIOTICS AND DIARRHOEA

The human gut is an incredible organism, hosting more than 400 species of microbes. Babies are born with a sterile gut and are naturally introduced to various microbes through the mode of delivery, via breastfeeding, formula and then again once solid foods are introduced.

Antibiotic Associated Diarrhoea (AAD) is linked to altered intestinal microflora and impaired mucosal integrity with the overgrowth of many enteropathogens. The incidence of diarrhoea in children receiving broad spectrum antibiotics has been reported in the range of 11 to 40%.

There is growing recognition that the intestinal microbiome undergoes significant change in composition during infancy and childhood. The diversity and ratio of microbes during this time are believed to be essential for protection from pathogens and the normal functional development of the immune system and its impact on health in later life.

Antibiotics such as aminopenicillins, cephalosporins and clindamycin are most commonly associated with diarrhoea.

DETRIMENTAL GUT EFFECTS OF ANTIBIOTIC TREATMENT Antimicrobial agents can significantly change the composition of both intestinal and oral microbiota. Effects are dependent on the spectrum and dosage, route of administration and treatment duration. Microbial diversity is often affected within days of commencing treatment and complete recovery of initial bacterial community composition is rarely achieved. In infants < 1 year, the detrimental effects on the native gut microbiotica is even more pronounced. Not only do they suffer overall reductions of bacterial community diversity, they have significant reductions in important Bifidobacterium and Bacteroides.

DEFINITION OF DIARRHOEA IN CHILDREN The World Health Organisation defines diarrhoea as three or more loose or liquid stools per 24 hours. There are a number of causes of diarrhoea in infants and children, including acute infectious diarrhoea and carbohydrate intolerance/malabsorption “toddler diarrhoea”; however, one of the most common causes in the western world is Antibiotic treatment.

Infection with C. difficile bacteria causes severe and sometimes life-threatening diarrhoea and inflammation in the colon, called colitis.

THE RATIONALE BEHIND PROBIOTICS Probiotics are known as the non-pathogenic bacteria which can benefit a host by positively altering the microflora through implantation or colonisation. The rationale behind their use in conjunction with antibiotics is based on the assumption that specific strains of probiotics act against intestinal pathogens “re-inoculating” and normalising unbalanced indigenous microflora. Importantly, probiotics have strain-specific effects, therefore different types of probiotics will have different physiological effects. The probiotics commonly administered in Randomised Controlled Trials are: Lactobacillus (Lactobacillus acidophilus, Lactobacillus bulgaris, Lactobacillus casei, Lactobacillus rhamnosus), Bifidobacteriu (Bifidobacteria bifidum, Bifidobacteria longum), Streptococcus (Streptococcus thermophiles) and Saccharomyces boulardii.

CAN PROBIOTICS REDUCE DIARRHOEA? A Cochrane review in 2015 revealed that there is moderate evidence for a protective effect of probiotics in preventing antibioticassociated diarrhoea. Among the various

probiotics evaluated, evidence suggests that Lactobacillus rhamnosus or Saccharomyces boulardii at 5 to 40 billion colony forming units/day may be appropriate. There is also evidence for the benefit of probiotics in the treatment of acute infectious diarrhoea in infants and children, particularly in rotaviral gastroenteritis. Lactobacillus GG showed the most consistent effect, although other probiotic strains may also be effective. Probiotics are documented as safe for use in healthy individuals. There are no safety concerns as the likelihood of adverse events are documented as being very rare. Probiotics have also been reported as safe for use in neonates, although the form used for infants is specific and different to that included in adult products. Probiotics are not generally advised for high risk groups such as immunocompromised, severely debilitated or those with central venous catheter.

WHAT TO PURCHASE Products labelled as “probiotic” are available in many different forms. There are dozens of brands of probiotic foods and supplements available, like yogurts or dairy drinks, capsules, powders and liquids. Choose products that contain the specific strain you are looking for and ensure that the probiotic is viable “through end of shelf life” rather than “at time of manufacture”.

REFERENCES: Goldenberg JZ, Lytvyn L, Steurich J, Parkin P, Mahant S, Johnston BC. Probiotics for the prevention of Paediatric antibiotic associated diarrhoea (Review). The Cochrane Library. 2015 Szajewska H and Mrukowicz, J. Probiotics in the Treatment and Prevention of Acute Infectious Diarrhoea in Infants and Children: A Systematic Review of Published Randomized, Double-Blind, PlaceboControlled Trials Journal of Paediatric Gastroenterology and Nutrition. 2001

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

HEALTH

VACCINATION

Vital for People with MICHELE GOLDMAN CEO Asthma Australia

MANY OF US DREAD THE COMING OF WINTER WITH THE CHILLY EVENINGS AND INEVITABLE BOUTS OF COLDS AND FLU. WHILE UNPLEASANT FOR MOST OF US, INFLUENZA CAN BE VERY SERIOUS FOR PEOPLE WITH ASTHMA AND CONTRIBUTES TO AN INCREASE IN THE NUMBER OF ASTHMA RELATED HOSPITALISATIONS IN WINTER.

In Australia, influenza on average causes 3,500 deaths, around 18,000 hospitalisations and 300,000 GP visits each year 1.

advice of community pharmacists is incredibly valuable in minimising the impact of asthma on patients and the wider community.

Asthma has many triggers but respiratory viruses, such as flu, are among the most common reasons that people with asthma will have increased symptoms or an asthma flare-up.

People with asthma are recommended to see their GP at least once a year for an asthma review but not everyone follows these guidelines. Also, flu may not always be top of mind during an annual consultation, for example during hay fever season.

Through the 1800 ASTHMA Helpline (1800 278 462), we hear a lot of stories from people with asthma who have been badly affected by flu. One mother told us about her son who was rushed to hospital late at night after picking up a virus on his first day at school; a woman in her 20s told us she had not had a holiday in years after using up sick leave and annual leave for hospital stays due to asthma, exacerbated by flu and viruses; another mum described her despair whilst sitting in ICU watching her young son struggling for breath due to viral-induced asthma. We cannot stop all respiratory viruses but we must make sure that people with asthma are aware of the dangers of flu and are strongly encouraged to get the flu vaccine. Flu vaccination is available free under the National Immunisation Program to eligible people, including those over 65. People with asthma are not covered unless they have another eligible condition or a diagnosis of severe asthma — that’s less than 10 per cent of the asthma population. As asthma affects 1 in 9 Australians, the

However, most people with asthma will visit their pharmacist on a regular basis to fill prescriptions for preventer medications, purchase reliever medications and to stock up on treatments for related conditions, such as eczema and hay fever. Now that the flu vaccination is being offered in many pharmacies, it is even more of a key opportunity for pharmacists to discuss vaccination. The flu vaccine can be offered from 6 months of age and it is recommended that all people with asthma and their families are vaccinated. Although there is a cost for those not covered under the National Immunisation Program, it is small in comparison to the potential sickness and days off school or work due to worsening asthma. The recent lives lost due to the thunderstorm asthma event in Melbourne serve as a stark reminder of just how serious asthma can be. Added to the financial toll revealed by the Hidden Costs of Asthma report, which showed asthma cost Australia

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

$28 billion dollars in 2015 due to healthcare costs, productivity losses and the burden on carers and families, it is clear we must do everything possible to support people with asthma. Many people have fears about vaccination and need to be reassured that vaccines have gone through a rigorous testing process before they are approved for use. The flu vaccine has a clear benefit for people with asthma, particularly those in high risk groups. Surveillance reports for the 2016 flu season show that flu cases were highest in older people (75+), followed by the youngest age group 0–5. The older age group is covered under the National Immunisation Program and fortunately uptake is good; however, it is highly important that parents of children being treated for asthma are aware of the risks of flu and the option of vaccination. As Australia’s most accessible health professionals, we hope pharmacists will help us spread the word. REFERENCE: http://www.isg.org.au/index.php/clinicalinformation/influenza-fast-facts-/

Information and support with asthma is available from Asthma Australia at www.asthmaaustralia.org.au or call the 1800 ASTHMA Helpline (1800 278 462).

“Now that the flu vaccination is being offered in many pharmacies, it is even more of a key opportunity for pharmacists to discuss vaccination.”

HEALTH

Asthma

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

BUSINESS

PHARMACY ALLIANCE

Rewards Members NIMFA MARTINEZ General Manager, Marketing and Member Services Pharmacy Alliance

A NEW ENVIRONMENT IS EMERGING AND PHARMACY BUSINESS MODELS NEED TO ADAPT TO MEET THEIR BUSINESS GOALS AND CUSTOMER NEEDS.

Pharmacies today and tomorrow can no longer be just ‘good’ operations. Regulatory changes will continue, consumers will demand more value and better services and competition will intensify. With this in mind Pharmacy Alliance has significantly changed their focus to make sure that their members optimise their pharmacy performance throughout their pharmacy, as well as attract and engage more customers. As such, Pharmacy Alliance has also recognised the need to show their members how being a member tangibly makes a difference to their pharmacy and reward them for more than dispensary generic performance.

MONTHLY BENEFIT STATEMENT Now more than ever member pharmacies are looking for value and to meet that need the membership benefit statement is a tool that has been developed. Every month, members receive a membership benefits statement that helps them to quickly and clearly identify through their Pharmacy Alliance membership how

much they are saving, how much rebate they are earning – and as such the total benefit. It also shows benefits that a member maybe missing out or they haven’t maximised as yet. As such every member has the opportunity to maximise their membership. On average our members receive just over $6,500 in wholesale savings each month alone (excluding directs and third party deals).

REWARDING BOTH OTC AND DISPENSARY PERFORMANCE In March 2017 we are introducing Alliance Rewards which is a total pharmacy solution designed for Pharmacy Alliance members to earn rebates for sales in both OTC and dispensary. It builds on the Pharmacy Alliance’s leading dispensary generics program, PAGM that rewards members for loyalty and substitution to their first line generic manufacturer. Independent Pharmacy needs to be sales focused in a move to replace lost profit from EAPD and grow top line sales. With the all new

Alliance Rewards members can drive sales and earn rebates across OTC categories and Core OTC lines, along with the existing PAGM and Private Label products. So not only will they be earning rebate from selling the right product mix for their pharmacy but they will be rewarded for it by earning rebates. This is unique to Pharmacy Alliance as no other membership group pays rebates on the sale of OTC and Private Label lines.

STRENGTH IN NUMBERS With the merge of SmarterPharm members into Pharmacy Alliance, the membership group is now 650 pharmacies across Australia. With the Pharmacy Alliance member benefit statement and Alliance Rewards it provides independent pharmacy to effectively compete with discounters and banners. It further means that we are able to continue to develop scalable tools like the member benefit statement and Alliance Rewards to benefit independent pharmacy.

"Alliance Rewards members can drive sales and earn rebates across OTC categories and Core OTC lines, along with the existing PAGM and Private Label products."

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

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BUSINESS

Community Pharmacy in the Digital Age Four Ways Pharmacy is Evolving through Technology

ROSS GALLAGHER

ROMA CECERE

CEO GuildLink

CSO GuildLink

DIGITAL HEALTH IS BIG BUSINESS GLOBALLY. DRIVEN BY THE WORLD HEALTH ORGANISATION (WHO) GLOBAL OBSERVATORY FOR EHEALTH, THE PRIMARY GOAL IS TO INCREASE THE ACCESSIBILITY OF HEALTH AND HEALTH INFORMATION, TO BOTH THE PATIENT AND HEALTHCARE PRACTITIONERSi. AS ONE OF THE WHO EHEALTH COUNTRIES, AND UNDER THE GUIDANCE OF THE AUSTRALIAN DIGITAL HEALTH AGENCY (ADHA), AUSTRALIA IS WELL ON ITS WAY TO REALISING ITS EHEALTH POTENTIAL.

When addressing the 2016 Australian Pharmacy Professional conference, the then Minister for Health, Aged Care and Sport, Sussan Ley, committed to finding new opportunities under the Government’s Innovation Agenda that would ‘re-launch and re-imagine digital health in Australia’ii, something that the Pharmacy Guild of Australia is committed to doing. In their May 2016 eHealth fact sheet, Pharmacy innovations in digital health (eHealth), the Guild outlined eight examples of areas that community pharmacy and supporting industries are innovating in the digital health spaceiii:

THE PHARMACY GUILD OF AUSTRALIA

Digital Health Innovations >> Online Pharmacy information tools >> PBS online >> National digital health record system >> Electronic transfer of prescriptions >> eRX script exchange >> National medicines repository >> Telehealth >> Patient support through IT systems

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

Minister Ley followed up her promise of new digital health opportunities by emphasising that the Australian ‘digital health revolution literally lies in the hands of consumers’iv. This may be true in many areas of the Australian health framework; however, it can be argued that this isn’t always the case in Community Pharmacy. Consumer-driven technology is important to patient interaction with pharmacy; nevertheless, there are a number of digital innovations that are driven by either the requirements of pharmacy professionals or industry incentive. The following four areas are examples of the Community Pharmacy industry driving digital evolution.

BUSINESS

"GuildCare NG is the next step in Professional Services technology that has been designed based on pharmacist requirements for a faster, easier and more intuitive user experience."

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

BUSINESS

DELIVERING PROFESSIONAL SERVICES THROUGH A TECHNOLOGY PARTNER Professional Services are fast becoming a key component of Community Pharmacy and they are best delivered through a technology partner. In her 2016 article, ‘The Rise of Technology in Community Pharmacy’, QCPP State Manager, Jacqueline Henricks, stipulates that electronic recording of Professional Services through a technology partner improves data quality, reduces the cost of services delivery for pharmacy ^ and saves valuable pharmacist staff time . In addition to these points, delivering Professional Services through a technology partner enables Community Pharmacy to generate accurate reporting, provide proof of service provision through 6CPA and other funding measures, as well as build on the growing database of health information that will continue to provide insight into the health of the Australian population. GuildCare NG is the next step in Professional Services technology that has been designed based on pharmacist requirements for a faster, easier and more

intuitive user experience. GuildCare NG continues to enable pharmacists to deliver Australia’s widest range of in-pharmacy Professional Services, with the added benefits of a new patient-centric design, intelligent reporting and customisable dashboard.

COMMUNICATING WITH AND EMPOWERING PATIENTS IN THE DIGITAL AGE A 2016 study conducted by market research firm, McKinsey & Company, has found that ‘increasing numbers of patients … are “digital citizens”, people who don’t simply use digital technology, but have fundamentally changed their expectations, world views and behaviours as a result of living in the digital age’vi. Though this research primarily focused on the expectations of patients in the United States, it can be argued that the expectations of Australian patients are likely to be the same, and the Australian government is advocating for patients to be ‘better educated about their needs and make better decisions about managing their own health’vii. Open and two-way communication with patients is fundamental to Community Pharmacy’s

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ability to empower patients to make better health decisions. The use of mobile device app solutions is increasingly becoming the method of choice for patient medication management and interaction. There are a number of pharmacy engagement mobile device app solutions available on the Australian market, each with a range of benefits and primary uses. As patients become more engaged with their health, it is important that apps on the market stay ahead of patients’ needs. While most pharmacy-to-patient apps on the Australian market focus primarily on script reminders and ease of refill, there is one that goes beyond simple script management and provides a holistic pharmacy relationship solution. Designed by GuildLink, myPharmacyLink is the first pharmacy-managed direct-to-patient app that allows patients to manage their scripts, find government-approved information about their medications, view and use inpharmacy professional services reports, and communicate with and find out key information about their chosen pharmacy — all under the guidance of their trusted pharmacist.

BUSINESS

myPharmacyLink has been designed around the user-experience of the patient, and its technical framework is built around driving customer loyalty to a specific pharmacy. The app aims to provide pharmacy with the tools and technology platform that empowers business to directly engage with their own patients. Managed from within the new GuildCare NG platform, the app closes the gap between patient and pharmacy, ensuring healthier results for the patient and the business.

COLLECTING AND USING BIG DATA Big data is a hot topic in the Australian healthcare industry. With the Australian Institute of Health and Welfare collecting and storing government-generated health data, as well as private industry collating their own data sets, it is important to acknowledge its significance in the health outcomes of Australian society. Linking data sets and analysing the findings, enables the Australian healthcare industry to take an evidence-based approach to specific health issues and can help to enable positive health outcomesviii. While the collection of and use of data

needs to be strongly protected — so as not to infringe the privacy of Australian patients — it is important to realise the potential that linked data sets can have on the health outcomes of Australians. As primary healthcare providers, there is a key role for Community Pharmacy to play in data collection and use, now and into the future. As a key Australian healthcare provider, Community Pharmacy is perfectly placed to contribute to and utilise Australian health data. For example, using a software solution like GuildCare NG to track and record health interactions and Professional Services, enables Community Pharmacy to become a collection point for front-line health data which will help the Australian government and healthcare industry to make educated decisions around preventative health.

ELECTRONIC CONSUMER MEDICINES INFORMATION The age of Consumer Medicines Information (CMI) being solely available to patients as a paper leaflet inside a medication package is largely ending. The industry-leading Electronic Distribution Working Group (EDWG) comprised

1 2 3

of large pharmaceutical groups, white knights and digital healthcare industry leaders, advocates that due to frequency of product changes and discovery of new research information, pharmaceutical companies are to store their consumer medicine information and product information digitallyix. To date, no fewer than 55 pharmaceutical companies selling products in Australia, actively use digital distribution as their primary method of medicines information distribution. Using GuildLink’s Secure Data Warehouse (SDWH), pharmaceutical companies can store up-to-date information about their medications that is then shared digitally and in real-time* across the SDWH network of dispense software vendors; consumer medicines information and government websites; health information providers and publishers; and consumer associations. Digital distribution of consumer medicines information provides Community Pharmacy with a unique opportunity to educate patients using the latest and most accurate information about the medication they are taking.

Print up-to-date, digitally distributed CMIs from dispense software vendors instore. Direct patients to government-approved medicines information website – www.medicines.org.au Invite patients to use a SDWH supported patient app, like myPharmacyLink.

INTERESTED IN HOW YOUR PHARMACY CAN ENGAGE WITH DIGITAL HEALTH INNOVATION THROUGH GUILDCARE NG OR MYPHARMACYLINK? Contact the GuildCare pharmacy services team — call 1300 859 328 or email pharmacy@guildlink.com.au REFERENCES: Global Observatory for eHealth — Global diffusion of eHealth: making universal health coverage achievable http://apps.who.int/iris/bitstream/10665/252529/1/9789241511780-eng.pdf?ua=1 ii 2016 APP Address – Minister for Health, Aged Care and Sport, Sussan Ley, MP. iii Pharmacy Guild – Pharmacy Innovations in eHealth — Fact Sheet, http://guild.org.au/docs/default-source/ public-documents/issues-and-resources/Fact-Sheets/pharmacy-innovations-in-ehealth.pdf?sfvrsn=0 iv 2016 APP Address – Minister for Health, Aged Care and Sport, Sussan Ley, MP. v ITK Feb/March 2016 Issue p. 47. vi Brian Fox & Paul Magill – McKinsey & Company, Transforming pharma commercial models in the age of the digital citizen, http://www.mckinseyonmarketingandsales.com/transforming-pharma-commercial-models-in-the-ageof-the-digital-citizen vii 2016 APP Address – Minister for Health, Aged Care and Sport, Sussan Ley, MP. viii Ian N Oliver, The Medical Journal of Australia — Linking data to improve health outcomes — https://www.mja.com.au — /journal/2014/200/7/linking-data-improve-health-outcomes ix EDWG website – http://www.edwg.com.au/ x GuildLink SDWH Data, February 2017. * Within 15 minutes. i

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

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The NAPSA Alumni Association exists so pharmacists from all stages of their careers can re-connect and forge new personal and professional relationships with each other. NAPSA alumni provides a platform to celebrate the fantastic roots of our industry as well as work conďŹ dently and co-operatively toward a bright future. Alumni members will have access to a range of events and opportunities geared towards fostering positive connections between them and our general members. These include professional networking, mentoring and teaching opportunities; and keeping up-to-date with NAPSA's current projects.

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HEALTH

Shakeitup.org.au

World Parkinson’s Day Tuesday 11 April 2017

CLYDE CAMPBELL

TODAY THERE ARE OVER 70,000 AUSTRALIANS LIVING WITH PARKINSON’S DISEASE AND THE NUMBER IS GROWING, WITH AN AVERAGE OF 32 NEW CASES DIAGNOSED EVERY DAY. SURPRISING TO MANY IS THE FACT THAT 20% OF THOSE DIAGNOSED ARE UNDER THE AGE OF 50. THIS IS NOT JUST AN OLD PERSON’S DISEASE.

Founder Shake It Up Australia Foundation

Average direct cost per person living with Parkinsons

15,500

per annum

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GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

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"32 new cases of Parkinson’s are diagnosed every day in Australia. Learn more about our supporters and their journeys on our website www.shakeitup.org.au"

Parkinson’s is a progressive and substantially debilitating neurodegenerative condition that affects people from all walks of life. As Parkinson’s prevalence increases threefold after the age of 65, the growth rate in the number of people living with Parkinson’s is expected to increase dramatically as the Australian population ages. Typically, symptoms appear once 70% of a person’s dopamine-producing cells have degenerated. This suggests that development of tools for early diagnosis and disease-modifying drugs would dramatically change what a diagnosis of Parkinson’s means. The average direct cost per person living with Parkinson’s is $15,500 per annum and the total financial cost of Parkinson’s is almost $1.1b per annum. Health expenditure costs per year are higher in comparison to other diseases that have higher profiles in the community, including breast and prostate cancer. Established in 2011, Shake It Up Australia Foundation is a not-for-profit organisation, raising money for Parkinson’s research in Australia. Partnered with the Michael J. Fox Foundation, our research is cutting edge, Australian based and aimed at one thing: finding a cure for Parkinson’s disease. What makes us unique? The Founding Directors cover all overhead and administration

costs which means that 100% of every donation goes to research targeted at finding better treatments and ultimately a cure for Parkinson’s disease. So far, Shake It Up has committed funds to 22 projects at nine Australian research institutes. One area of research critical to the global quest for a cure is the search for suitable biomarkers. Professor Dominic Rowe AM heads up the Australian site of the Parkinson’s Progression Markers Initiative (PPMI). It is argued that this worldwide study will be a ‘game changer’ in Parkinson’s research. PPMI is an observational research study led by the Michael J. Fox Foundation to identify biomarkers of Parkinson’s disease progression. The fiveyear study is currently running at 24 sites throughout the United States, Europe and Australia. Shake It Up’s partnership with the Michael J. Fox Foundation was central to a site being established in Australia and Professor Rowe’s involvement puts him at the forefront of biomarker research worldwide. A biomarker is a substance or characteristic in our bodies that is associated with the presence of disease, or that changes over time in a way that can be linked to the progression of disease. An observational study means

that study participants undergo numerous tests and assessments of bodily processes related to Parkinson’s, but do not receive an experimental drug or treatment. This study uses a combination of imaging techniques, collection of blood, urine and spinal fluid, and clinical tests. PPMI is sponsored by the Michael J. Fox Foundation and funded in Australia by Shake It Up Australia Foundation. Shake It Up’s funding commitment is approximately $1M over five years. Since 2011, Shake It Up has committed $3M to Australian Parkinson’s research. Our founders cover all our administration costs so 100% of all contributions go to research. Our mission is clear: to find the cure for Parkinson’s disease. And we will. Since the inaugural Pause 4 Parkinson’s campaign in 2015, we have been able to raise over $230,000 and have had over 5,000 supporters participate nationally over the last two years. This campaign alone has allowed Shake It Up to reach over 500,000 people around Australia through traditional means and social media coverage. On World Parkinson’s Day, Tuesday 11 April 2017, we are asking Australians to stop, pause and give a voice to those affected by Parkinson’s. Please support us www.shakeitup.org.au

"Typically, symptoms appear once 70% of a person’s dopamine-producing cells have degenerated".

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F ion a, Parkinson's Suf ferer GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

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PRODUCT INSIGHT

SOUTHERNATURE Quality Natural Solution SOUTHERNATURE IS A NEW, 100% AUSTRALIAN MADE AND OWNED BRAND WHICH IS PASSIONATE ABOUT DELIVERING QUALITY PRODUCTS MADE WITH THE BEST RAW MATERIALS AT OUR AVAILABILITY TO CONSUMERS. WE FEEL STRONGLY ABOUT DELIVERING PRODUCTS ALIGNED WITH KEY VALUES WHICH SUPPORT HEALTH AND WELLBEING FOR OUR CUSTOMERS.

We at SOUTHERNATURE have listened to our customers’ health interests which include clean and quality products they can give to their whole family. As a result, we have endeavoured to cater for a number of health needs and have developed products which span over five ranges, including: General Health, Women’s Health, Men’s Health, Children’s Health and a Functional Health Range, which contains a number of quality herbal ingredients. Additionally, due to our commitment to our customers we have registered our products with a number of industry bodies which stand for quality and sustainability. We have gained accreditation with these organisations and are proud to display their logos.

AUSTRALIAN GMP All of SOUTHERNATURE'S products are made in Australia under Australian GMP. We only manufacture our products in Australia, ensuring our products are made to the highest manufacturing standards.

AUSTRALIAN MADE SOUTHERNATURE is extremely proud to display the Australian Made logo on all of our products. The Australian Made logo is Australia’s most trusted and recognised symbol for products that are made in Australia. When you purchase SOUTHERNATURE products, you are guaranteed of purchasing a quality Australian Made product.

THE INTERNATIONAL FISH OIL STANDARDS™ (IFOS™) PROGRAM In our commitment to quality, we have our fish oil independently tested and certified by fish oil industry leader IFOS. IFOS tests fish oil products to ascertain the active ingredient content, possible contaminants, and to analyse fish oil freshness.

distinction across all our fish oil ranges, including General Health, Women’s Health and Children’s Health, and have maintained the highest rating of 5 stars throughout our time of certification with IFOS. We are the only Australian brand to have all of our fish oils (including our Children’s fish oil) registered with IFOS.

GLOBAL ORGANISATION OF EPA AND DHA OMEGA-3S (GOED) The vision of GOED is to help consumers worldwide reach better EPA and DHA omega-3 levels in their diet. GOED members are committed to responsibly develop, sustain, and expand markets for EPA & DHA Omega-3s, as well as promote their health benefits and ethical business practices. SOUTHERNATURE'S fish oil range utilises only GOED membership raw materials, which ensures the raw materials we use are safe and are of high quality.

FRIEND OF THE SEA Friend of the Sea is a non-profit, non-governmental organisation (NGO), whose mission is the conservation of the marine habitat. Friend of the Sea is now a leading international certification organisation for products, originating from both sustainable fisheries and aquaculture. SOUTHERNATURE is proud to be certified by Friend of the Sea. At SOUTHERNATURE we ensure our fish oils are derived from Friend of the Sea approved suppliers only, and support sustainable fishing practices to help ensure the environment for future generations.

We are proud to say that SOUTHERNATURE has consistently gained IFOS’s highest score and rating of 5 stars. We have gained this GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

VEGAN FRIENDLY Veganism is a lifestyle which is gaining popularity due to its bountiful health benefits. Our VeganFriendly range is free from all animal derived ingredients, including dairy products. In a commitment to consumer health needs, our Vegan Range even utilises vegan capsules to ensure quality encapsulated products which are 100% safe for vegans. (Excludes fish oil capsules)

VEGETARIAN FRIENDLY Additionally, we have completely vegetarian products to offer our health-conscious customers, ensuring that our products are vegetarian friendly, including utilising gelatine-free capsules.

HALAL AUSTRALIA At SOUTHERNATURE we see ourselves as a communitybased brand which caters to all aspects of the Australian community. We at SOUTHERNATURE use only raw materials which are manufactured in compliance with Sharia law — including our capsules. At SOUTHERNATURE we are committed to quality products for the Australian marketplace and we hope you will enjoy SOUTHERNATURE products as much as we do. We wish you and your family all the very best of health, SOUTHERNATURE

PRODUCT INSIGHT

Compounding for Paediatrics COMPOUNDING IS THE TRADITIONAL METHOD OF CREATING PERSONALISED MEDICINES FOR UNIQUE PATIENT NEEDS. WITH THE ADVENT OF MASS DRUG MANUFACTURING IN THE 1950S AND '60S, COMPOUNDING DECLINED. However, the "one-size-fits-all" nature of mass-produced medications doesn't always account for the differences between individuals. With a shift in public awareness, you now see an increase in compounding available in community pharmacies. Compounding can help provide solutions for patients of all ages, with all types of conditions. It is especially useful with some of the common issues seen in Paediatrics.

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) ADHD is a chronic condition that cannot be cured, but can be treated â&#x20AC;&#x201D; and compounding may help. One of the most common reasons healthcare providers turn to compounding is for alternate dosage forms. This is especially common with ADHD treatment, as children often resist taking oral medications. Additionally, patients suffering from ADHD may not be able to use commercially available medications due to their dietary restrictions. Compounding allows pharmacists to alter a medication's ingredients, making treatment available to a larger group of people.

WOUNDS AND SCARS Children's active lifestyles make them prone to a variety of injuries, from everyday cuts and scrapes to more serious wounds. Once the child's injuries are attended to, parents are often concerned about permanent scarring. Compounding, especially using PCCA's exclusive bases like PracaSilTM-Plus, can help address these concerns, especially when used immediately on new wounds.

LICE INFESTATIONS Head lice are very difficult to treat once they have been contracted, so it is best to take preventative measures with schoolaged children between the ages of 3 and 11. Compounding provides opportunities to promote lice repellent hair sprays in your community. Many of the commercial products used to treat head lice infestations contain pesticides that can be absorbed through the skin. This creates a further opportunity for pharmacists to compound more natural alternatives.

ATHLETIC INJURIES

among children, especially school-aged youngsters. That, combined with a trend of less-inhibited behaviour, makes children prone to athletic injuries. Compounding can provide pain management solutions in the form of creams or gels applied directly to wounds, which is especially useful for children who may not be willing or able to swallow pills or accept other types of oral medication. Compounding pharmacists make more than medicine â&#x20AC;&#x201D; they make a difference. The above examples are just a few of the many solutions made available by compounding. Additionally, compounding can be personally and professionally rewarding for pharmacists, allowing them to explore their creativity and help a wider variety of patients.

For more information on getting started in the industry or expanding your independent pharmacy's practice, contact PCCA Australia on (02) 9316 1500 or visit pccarx.com.au/join-pcca

Team sport participation is very common

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

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INDUSTRY NEWS & UPDATES ``PHARMACISTS URGED TO ADOPT NEW ‘GOLDEN RULES OF INJECTION TECHNIQUE’ BD is encouraging healthcare professionals to play a more proactive role in the management of patients with insulindependent diabetes, following global research that revealed many people are not injecting their diabetes medication correctly. The new ‘Golden Rules of Injection Technique’ are based on the outcomes of FITTER (Forum for Injection Technique & Therapy Expert Recommendations)*, an international workshop sponsored by BD. FITTER brought together over 180 diabetes experts from 54 countries to review diabetes management practices and analyse the results of the largest-ever global survey on injection technique, which consisted of 13,289 respondents from 42 countries. Professor Glen Maberly, Senior Staff Specialist (Endocrinology) and Program Lead – Western Sydney Diabetes, who also attended the FITTER Workshop, said injection technique plays a critical role in diabetes care. “FITTER is a revered group of diabetes experts who seek to share the most up-to-date clinical evidence and best practice with their health professional peers and patients globally,” said Professor Maberly.

“When we are talking about diabetes care, injection technique is just as important as insulin, nutrition and physical activity. All healthcare professionals who are involved in the care of a patient with diabetes should be having regular, proactive conversations about injection technique, which include the importance of needle length, injection angle, using a skin fold and correct injection site rotation.” The FITTER recommendations, including the Golden Rules of Injection Technique and details of the global injection technique survey, were recently published in the esteemed U.S. journal, Mayo Clinic Proceedings, and can be accessed via the links below: • New Insulin Delivery Recommendations – http://www.sciencedirect.com/science/article/pii/S0025619616303214 • Worldwide Injection Technique Questionnaire Study: Population Parameters and Injection Practices – http://www.sciencedirect.com/science/article/pii/S0025619616303226 • Worldwide Injection Technique Questionnaire Study: Injecting Complications and the Role of the Professional – http://www.sciencedirect.com/science/article/pii/S0025619616303263

``IS YOUR PHARMACY READY FOR INFLUENZA VACCINATION SEASON? Influenza Vaccination Season is a huge opportunity for pharmacies across Australia to drive significant foot traffic into your stores and drive real revenue – but are you ready to make the most of it? Imagine a highly customisable solution that allows your pharmacy to take appointments for vaccinations online through your website at any time of day or night, take pre-service payments – and all of this integrated into your existing pharmacy applications, loyalty programs, Medicare and the Australian Immunisation Register.

Powered by GObookings, our online pharmacy vaccination portal gives your pharmacy an online presence without the need for expensive servers or infrastructure, while providing an easy to use solution allowing for better management of one-on-one appointments, 24/7. Want to learn more about how GObookings can help your pharmacy make the most of the 2017 Influenza Vaccination Season? Visit 1stgrp.com/pharmacy or head to page 30.

``LONG-CHAIN OMEGA-3 FATTY ACIDS "Long-chain omega-3 fatty acids (LC-03 PUFA) have been widely studied over the past four decades. We now know the incidence of sudden cardiac death may be reduced by up to 90% in individuals with a high Omega-3 Index, yet only 20% of Australians get enough omega-3s. A person’s Omega-3 Index can be measured with a new finger-prick test, and levels can be increased with

supplementation. Studies have found krill oil can provide an efficient means of delivering omega-3 fatty acids at a lower dosage than fish oil" – Ian Chant, General Manager, Aker BioMarine Antarctic Australia. More information available at www.omega3.net.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

INDUSTRY NEWS & UPDATES

``SKINB5 — SUPPORTING AUSTRALIAN COMMUNITY PHARMACIES WITH NEW DISTRIBUTION CHANNELS AND FREE PHARMACY SUPPORT PROGRAM SkinB5, an Australian company, delivers patented and innovative Natural Acne Treatment Supplements and Skincare System. SkinB5 is designed to treat all types of acne at the source, and it WORKS! Since 2006, SkinB5 has successfully treated thousands of acne sufferers across the world.

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“Acne has a Weakness!” Treat Acne from WITHIN using SkinB5 Natural Acne Treatment. with a range of training and patient information, which will enable pharmacists and pharmacy assistants to facilitate patient suitability for acne treatment with SkinB5’s Complete Acne Control System. To learn more, visit our website www.skinb5.com Contact: Lisa Reichenberger — Email: pharmacy@skinb5.com

SkinB5 is pleased to support Australian community pharmacies

``MILEASE – NEW RULES OF LEASING MiLease – New Rules of Leasing is a Membership only program delivered by the TEAM at LEASE1 – to provide the tools, support and education for all Industry stakeholders. Whether you are a CEO, Portfolio Manager, Franchisor, Broker, Financier, Franchisee/Licensee, Owner of a group of shops or a single outlet Retailer, there is a Membership level that will add value to your business whilst being part of the transition to more profitable relationships throughout your Retail business. From your own Lease Coach through educational webinars and workshops including regular reports and reviews of your business performance (and numerous other tools) there is opportunity to gain the insights into unlocking the hidden value in your lease/portfolio to meet not only current but future challenges of running a profitable retail business.

Supported by associated industry professionals MiLease-New Rules of Leasing will have exclusive access to The New Rules of Retailing and importantly The New Rules of Negotiation programs being rolled out within the membership program (depending on Membership level). With so much packaged into the Platinum and Gold memberships numbers, have to be limited to 200 and 300 respectively and are filling up quickly. One of the key benefits of the Platinum membership is the dedicated Lease Coach/Executive who will not only be constantly reviewing performance and managing your occupancy costs but will also deliver on your specific lease event such as lease renewal or option included in the subscription. >> www.milease.com.au

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ALWAYS READ THE LABEL. USE ONLY AS DIRECTED. IF SYMPTOMS PERSIST SEE YOUR HEALTHCARE PROFESSIONAL.

sales@southernature.com.au GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

60 SECONDS

WITH...

PETER HICKEY

My best getaway ever was …

Deception Bay Pharmacy

Always the next one, we look forward to them so much. A cruise around the Greek Islands was pretty special!

I decided to become a pharmacist because … I found Science and Maths interesting at school and so thought a career in the Health Sciences would suit me. I had a family relation who owned a few successful pharmacies, which made me think to go down that path.

I have been working as a pharmacist for … Coming up to 39 years with a couple of years off for travel and study. That must put me in the veteran status.

What I like best about my job is … When you are in a business this long, you develop rapport with customers you have helped over the years. They trust your advice and that’s a rewarding feeling. Every day is different with all sorts of challenges to face. It has been satisfying to see loyal team members grow during that time.

My favourite hobbies are ...

How I keep myself updated on the market news … Read a lot of the journals, Pharmacy Guild updates, and lunches with some good pharmacy mates.

Over the next three years in pharmacy, I predict … Professional services will be essential in keeping pharmacy viable. Graduates are so well trained these days. Being well equipped to handle changes, they will find their work more satisfying. Dispensing robots will become commonplace, which will allow pharmacists time to perform professional services.

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

Sport (more watching these days than playing), reading, lunch with mates, and holidays with my wife.

My favourite book is … When you get to my age, it is difficult to pin down just one favourite book. Here are a few- “To Kill a Mockingbird” by Harper Lee, anything from John Irving, “The Alexandria Quartet” by Lawrence Durrell, “The Vincibles” by Gideon Haigh.

Don’t listen to the negative talk about the future of pharmacy. I nearly didn’t buy into pharmacy 30 years ago because the industry was predicting Coles and Woolworths would take over pharmacy. Whatever happens, we will do it better. Don’t be afraid to take chances when they come your way … it will at least make life interesting.

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VISIT VICTORIA HAS PARTNERED WITH EVENT MANAGEMENT COMPANY IMG TO PROMOTE THE NEWLY RE-BRANDED GREAT OCEAN ROAD RUNNING FESTIVAL TO A GLOBAL AUDIENCE.

Previously known as the Great Ocean Road Marathon, the re-named event will offer a range of new activities this year, running over May 20 and 21. Victoria’s Minister for Tourism and Major Events John Eren said the festival will attract people from all over the world. “There’s no destination for a running event quite as picturesque as the Great Ocean Road.

This is a rare opportunity to run one of the world’s most stunning courses,” he said. “Runners from all over the state will join visitors from around Australia and the world to tackle the gruelling circuit. That’s a big boost to local businesses and the economy.” In addition to the six running distances on offer, the 2017 event will see the introduction of a scenic walk along the Great Ocean Road

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

as well as “Festival Hubs” at the Lorne Hotel and Lorne Theatre, as part of the soon to be launched Lorne Passport, enabling visitors to explore more of the seaside town. IMG event director Marcus Gale said the Lorne Passport will enhance the experience for participants and help “increase the economic impact of the event for the region and the communities along the Great Ocean Road”.

HEALTH CALENDAR

A P R I L /M AY 2 0 17 IBS AWARENESS MONTH 1st – 30th April >> www.whathealth.com

INTERNATIONAL NO DIET DAY 6th May >> www.nationalcalendar.com.au

While the cause of IBS is not known, it is thought that the symptoms of IBS are brought on by a disruption to the interaction between brain, nervous system and gut. Many people believe that stress is a cause of IBS. However this is not the case although stress can make the symptoms of IBS worse or trigger them.

The idea of having an enjoyable and healthy relationship with food is at the heart of International No Diet Day.

Irritable Bowel Syndrome (IBS) is a common disorder. According to the International Foundation for Functional Gastrointestinal Disorders (IFFGD), it's estimated that between 9-23% of the global population is affected by IBS; over 30 million people in the United States have this condition. IBS is also more common in females accounting for two out of every three cases. IBS cannot be cured, however once medical assistance is sought and the condition managed, IBS may create minimal or no disruption to a person’s life. In many cases, people with IBS do not seek help or even discuss it with other people. The word 'bowel' can bring negative connotations; many people do not want the word 'bowel' associated with them. The month of April was first designated as IBS Awareness Month in 1997 and 'Don't Suffer in Silence' is a common theme used in this awareness campaign. ...........................................................................................................

Celebrate this way of thinking today by sharing good food with friends, family and work mates. ...........................................................................................................

WORLD AUTISM AWARENESS DAY 2nd April >> www.goblueforautism.com.au

An annual celebration of body acceptance and body shape diversity, INDD is dedicated to promoting a healthy life style and raising awareness of the dangers and futility of dieting.

MENSTRUAL HYGIENE DAY 28th May >> www.menstrualhygieneday.org To create a world in which every woman and girl can manage her menstruation in a hygienic way – wherever she is – in privacy, safety and with dignity. Menstrual Hygiene Day will help to break the silence and build awareness about the fundamental role that good menstrual hygiene management (MHM) plays in enabling women and girls to reach their full potential. Menstrual Hygiene Day (MH Day) is a global platform that brings together non-profits, government agencies, the private sector, media and individuals to promote Menstrual Hygiene Management (MHM). MH Day raises awareness of the challenges women and girls worldwide face due to their menstruation and highlights solutions that address these challenges, including through media work.

Go Blue from April 2 to help raise awareness and funds to support individuals living with ASD and their families.

It catalyses a growing, global movement for MHM and supports partnerships at global, regional, national and local level. MH Day also creates opportunities for advocacy for the integration of MHM into global, national and local policies, programmes and projects. ...........................................................................................................

On Saturday, April 2, 2017, World Autism Awareness Day, iconic buildings across Australia and the world will turn their lights blue for the month to promote autism awareness. Autism Queensland supports this global initiative through its annual Go Blue for Autism campaign when we ask our supporters to help raise awareness and funds to support people living with ASD and their families by holding an event or attending one being held in their local community. In 2017 all funds raised through Go Blue for Autism will help Autism Queensland provide education, therapy and support services for children and adults living with autism. ...........................................................................................................

WORLD PARKINSON’S DAY 11th April >> www.daysoftheyear.com

WORLD NO TOBACCO DAY 31st May >> www.who.int Every year, on 31 May, WHO and partners mark World No Tobacco Day (WNTD), highlighting the health and additional risks associated with tobacco use, and advocating for effective policies to reduce tobacco consumption. The theme for World No Tobacco Day 2017 is "Tobacco – a threat to development." In addition to saving lives and reducing health inequalities, comprehensive tobacco control contains the adverse environmental impact of tobacco growing, manufacturing, trade and consumption.

World Parkinson’s Disease Day marks the birthday of Dr. J Parkinson. On this day there are efforts made to increase the public awareness of this terrible disease, as well as all the good works put forth by the worlds organizations dedicated to eradicating this disease. There are activities to promote this the entire world over, and the opportunity to participate is open to any and all who want to help in this effort. Dr. Parkinson first described the disease in “An Essay on the Shaking Palsy”, he described a pattern of lessened muscular power, involuntary tremulous motion, even if these are supported. There is at tendency to bend the body forwards, and to involuntarily switch from a walking to a running pace, while the sense and intellect deteriorate.

Tobacco control can break the cycle of poverty, contribute to ending hunger, promote sustainable agriculture and economic growth, and combat climate change. Increasing taxes on tobacco products can also be used to finance universal health coverage and other development programs of the government. It is not only governments who can step up tobacco control efforts: people can contribute on an individual level to making a sustainable, tobacco-free world. People can commit to never take up tobacco products. Those who do use tobacco can quit the habit, or seek help in doing so, which will in turn protect their health as well as people exposed to second-hand smoke, including children, other family members and friends.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

Health Destination Hub

It was Albert Einstein who said, â&#x20AC;&#x2DC;Try not to become a man of success, but rather a man of valueâ&#x20AC;&#x2122;. Having spent the last few months working in a number of different and busy pharmacies, I have found myself facing a new...

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Please review the full product information before recommending, available at www.maxigesic.com.au References: 1. Merry, A. F., Gibbs, R. D., Edwards, J., Ting, G. S., Frampton, C., Davies, E. and Anderson, B. J. (2010). “Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial” British Journal of Anaesthesia 104(1): 80–88. Result achieved in a trial of post-operative pain relief after removal of 1–4 wisdom teeth using Maxigesic® compared with Paracetamol 4000mg or Ibuprofen 1200mg alone per day in four divided doses. 2. Mehlisch, D. R., Aspley, S., Daniels, S. E., & Bandy, D. P. (2010). Comparison of the analgesic efficacy of concurrent ibuprofen and paracetamol with ibuprofen or paracetamol alone in the management of moderate to severe acute postoperative dental pain in adolescents and adults: A randomized, double-blind, placebo-controlled, parallel-group, single-dose, two-center, modified factorial study. Clinical Therapeutics, 32(5), 882–895. doi:10.1016/j.clinthera.2010.04.022 *2 tablets of Maxigesic taken every 6 hours over a 24 hour period (8 tablets maximum). Maxigesic® film coated tablets (Paracetamol 500mg and Ibuprofen 150mg; 10s, 12s, 16s, 24s and 30s) are for the temporary relief of pain and reduction of fever. Do not use if you have asthma or a stomach ulcer. Do not use in children under 12 years or if you have kidney disease. Do not exceed the daily recommended dose. Do not combine with any other Paracetamol or Ibuprofen containing medicines. Always read the label. Use only as directed. Incorrect use can be harmful. If symptoms persist consult your healthcare professional. Patent No. 2005260243.

BUSINESS DIRECTORY

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

Business Directory ADVANGEN 18/15 Castlereagh St, Sydney NSW 2000 (02) 9233 8975 >> www.evolisproducts.com.au

FLOWSELL 1/13 Network Dve, Carrum Downs VIC 3201 Tel: 03 9708 2276 >> www.flowsell.com.au

ASTHMA AUSTRALIA 42 Costin St, Fortitude Valley QLD 4006 P: 07 3252 7677 >> www.asthmaaustralia.org.au

GOLD CROSS Level 3, Archtis House 10 National Circuit, Barton ACT 2600 Tel: 02 6270 8950 >> www.goldx.com.au

AUSTRALIAN COLLEGE OF PHARMACY Level 2, 9/65 Tennant St, Fyshwick ACT 2609 Tel: 02 6188 4320 >> www.acp.edu.au

BOD AUSTRALIA Level 1, 377 New South Head Road Double Bay NSW 2028 Ph: +612 9199 5018 >> www.bodaustralia.com

group 1ST GROUP 2C, 2-12 Foveaux St, Surry Hills NSW 2010 Tel: 1300 266 517 >> www.myhealth1st.com.au

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

HEAT GROUP 35 Centre Rd, Scoresby VIC 3179 Ph: +61 (0) 3 8545 7100 >> www.heatgroup.com.au

LEASE1 Retailer House â&#x20AC;&#x201C; Level 1, Unit 3 321 Kelvin Grove Road Kelvin Grove QLD 4059 Tel: 1300 766 369 >> www.lease1.com.au

OLYMPIA PUBLISHING 19 Ravenswood Road Maida Vale WA 6057 Tel: 1800 628 388 >> www.olympiapublishing.com.au

PCCA 1/73 Beauchamp Road Matraville NSW 2036 Tel: 1300 722 269 >> www.pccarx.com.au

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

PHARMACY GUILD Guild House, 40 Burwood Road Hawthorn VIC 3122 Tel: 03 9810 9999 >> www.guild.org.au

DOSE INNOVATIONS 20B Lathe St, Virginia QLD 4014 Tel: 1800 003 673 >> www.doseinnovations.com

DIETICIANS ASSOCIATION OF AUST. 1/8 Phipps Close, Deakon ACT 2600 Tel: 02 6163 5200 >> www.daa.asn.au

MEDICATION PACKAGING SYSTEMS AUSTRALIA 8 Clunies Ross Court Eight Mile Plains QLD 4113 Tel: 07 3364 0300 >> www.mps-aust.com.au

SHAKEITUP 1/101 Derby St, Silverwater NSW 2128 Tel: 1300 361 803 >> www.shakeitup.org.au

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

SOUTHERNATURE 4 Bridge St, Rydalmere NSW 2116 Tel: 02 9684 6555 >> www.southernature.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 53 : APRIL/MAY 2017

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