ITK June/July 2014 - Edition 36

ISSUE #36 : JUNE / JULY 2014

P r a c t i c a l I n f o r m at i o n f o r T o d a y ’ s C o m m u n i t y P h a r m a c i s t

IN THE KNOW

• Bounce back from PBS • Mystery Shopper – Protocols reforms • Neuropathic pain • efficiency in pharmacy • Pre-conception, Planning • Managing the mother load and Interconception Care

Let’s talk breakthrough reflux 1 in 3 people on prescription medication still experience occasional breakthrough reflux symptoms.1,2 Start talking breakthrough reflux with your customers today.

Visit rbhealthhub.com.au to order your Gaviscon trial samples.

References: 1. Donnellan C et al. Cochrane Database Syst Rev 2010; (2): CD003245. 2. El-Sarag H et al. Aliment Pharmacol Ther 2010; 32(6): 720–37.

Always read the label. Use only as directed. If symptoms persist see your healthcare professional. ® Gaviscon is a registered trademark of RB Australia.

44 Wharf Road, West Ryde, NSW 2114. RBGA8327/ITK/FP. April 2014. Ward6.

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CONTENTS

TRUST, SERVICE AND ADVICE

SPECIAL FEATURE 4

CPD – Pre-conception, Planning and Interconception Care

PROFFESSIONAL REVIEW 10 A sensitive topic – Incontinence 14 Managing the mother load 16 Right advice is key 18 Neuropathic pain 24 Chronic Pain

BY SEAN TUNNY

TRAINING AND EDUCATION

Editor, Gold Cross Products & Services Pty Ltd

20 Pain it’s something we would like to do without

Recently, I had the opportunity to attend the parent–teacher interview for my daughter Breanna at her school. Prior to the interviews I was given a tour of the school by Breanna and an idea of the type of questions that we could possibly talk to the teacher about. As invariably occurs, each teacher advised that Breanna had expressed clearly what she would like to pursue in life. Amusingly, the career path for my children, perhaps like many of our readers has taken a few turns from being a vet, to scientist, professional sports player and police officer. With four more years of school prior to finishing year 12, it will be interesting to see how many more career options are considered — perhaps even pharmacy.

During APP this year, I found myself talking to a number of people from various sectors about our profession. The industry, as we know, is made up of many sectors, and the sum of many of my discussions was that, although some people move around and sometimes away from the industry for a time, it is a profession that has a strong community acceptance and, for the most part, a great environment, and they often find their way back. I reminded my children that a career in our industry was well worth considering, despite the challenges that prevail.

As June officially signals the start of winter and Queensland being at least one up in the State of Origin, it is the favourite time of year for many. Ski trips, rugging up, warm soups, open fires and a weekend sleep-in are just some of the highlights. The temperatures are already in the low single digits while our national capital is recording minus temperatures.

This edition from front cover to back is full of exciting features, reviews and editorials.

Our Business Profiles from Paper-Pak and Thomas Brown Shopfitters are most informative. In addition, CPD training, a host of professional editorials and our regular features complete the edition. Thank you to all the contributors, partners and supporters of ITK. Best of Health.

Sean Tunny Editor

BROUGHT TO YOU BY:

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32 Helping customers get the right balance 34 Calming the little ones coughs with ivy leaf extract 37 Maintaining good nasal health 40 Aci-Jel Restore and Rectogesic

OTHER FEATURES 28 Mystery Shopper – Protocols

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35 Type 2 Diabetes

GUILD NEWS 3 News from the National Guild President 44 Guildcare – Creating efficiency in pharmacy

BUSINESS PROFILE 22 Paper-Pak 46 Thomas Brown Shopfitters

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DOWN TO BUSINESS 26 Bounce back from PBS reforms 30 Pharmacy Ownership: Buying and Selling 42 How to find and retain high-quality employees 48 The need for tighter stock control 56 Is your pharmacy sale ready?

AFTER HOURS

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58 Upcoming Winter festivals and events

REGULARS 50 What’s new and Company news 54 Product Spotlight 59 60 Seconds Interview 60 Health Calendar 62 Classifieds 64 business directory

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

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

PROUDLY AUDITED BY:

DESIGN: Megan Hibberd

0408 452 133 www.artbymegan.com.au PRINT & DISTRIBUTION: APN Print

1300 134 628 www.apnprint.com.au PUBLISHED BY: Gold Cross Products & Services. PO Box 505 Spring Hill Qld 4004.

Contact Candice Radford Email: Candice.radford@goldx.com.au In The Know is produced for the information of Australian Pharmacists. The presence of the logo of the Pharmacy Guild does not constitue endorsement of a product. The Pharmacy Guild of Australia accepts no responsibility for claims made by advertisers. Opinions and views expressed in articles do not necessarily reflect those of Gold Cross.

NEWS FROM THE GUILD PRESIDENT

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Healthy Questions George Tambassis National President of The Pharmacy Guild of Australia

Lots of people have opinions about whether pharmacists and pharmacy staff ask too many questions when customers are trying to buy medications. I am sure you have heard some of the complaints that it is an invasion of privacy and none of our business.

A Fairfax Media article recently discussed pharmacists and pharmacy staff copping abuse and threats from customers who had been refused addictive over-the-counter medicines, particularly those products containing codeine. The newspaper said the cranky exchanges have been dubbed ‘codeine tantrums’. One Melbourne pharmacist from a busy community pharmacy reported up to four such tantrums an hour at his dispensary.

This story obviously touched a sensitive nerve with many people in our industry because when we put it on our Facebook site, it received a record number of visits.

This led me to think that many pharmacy assistants may have been suffering this reaction in silence. The report provided a snapshot of the challenges faced by many pharmacists and pharmacy assistants serving in the community each and every day.

It is a troublesome area because so many people do not seem to understand the way the medicine schedules work and the good health policy objective that underpins them.

Too few people recognise that without the schedules, and without the requirement for a pharmacist to be involved and seek information when supplying schedule 3 pharmacist-only medicines, many medicines that are currently available without a prescription would no longer be available without a visit to a doctor and a script.

Recently I had an opportunity to visit several countries in Europe to have a look

“Without any official way to keep track of codeine sales, pharmacists say they are unable to identify codeine addicts who could be at risk of horrendous internal injury, such as acute renal failure.”

at how their pharmacy sectors are performing.

Some European countries have models with similarities to our pharmacy model, but none has a comparable scheduling system. I believe Australia’s medicine scheduling arrangements are world best practice.

The article noted that without any official way to keep track of codeine sales, pharmacists say they are unable to identify codeine addicts who could be at risk of horrendous internal injury, such as acute renal failure.

Popular codeine tablets taken in large amounts have caused at least nine deaths in Victoria since 2001, but industry experts say there is a common misconception that all over-the-counter drugs are ‘harmless’.

The Pharmacy Guild of Australia supports the idea of a real-time monitoring system that would help make objective, not subjective, judgements on whether there is a risk of drug dependency rather than

a genuine therapeutic need and, most importantly, referring those who may need further assistance overcoming a drugdependency problem to the help they need.

Unfortunately, there is no current realtime monitoring system that is suitable or authorised for the purposes of monitoring over-the-counter codeine sales. Project STOP is restricted to real-time recording of products containing pseudoephedrine, and targets specific issues around illegal diversion of drugs, rather than personal addiction.

Such a technological advance in relation to codeine sales, when it comes, will not solve the problem of the terse customer who disputes the need for, or authority of, a pharmacist or pharmacy staff to ask appropriate questions about use of medicines.

Unfortunately, we will all have to keep doing our best to explain the need for such information—and occasionally bite our tongues.

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Pharmacists Play a Pivotal Role in

Pre-conception Planning and Interconception Care Melissa Antonel B.Pharm

Australian community pharmacists are accessible and provide a wealth of knowledge, practical support and assistance for customers at the essential planning stages before and during pregnancy as well as following childbirth.

Such ease of access can alleviate concerns, ensure optimum health and enhance a customer’s transition through a life-changing experience.

As healthcare professionals, pharmacists can significantly enhance the attitudes and approach of customers in relation to pre-conception and Interconception care.

The pre-conception stage, traditionally 3 months prior to pregnancy, is the ideal period in which pharmacists are able to advise and assist customers to prepare for pregnancy and parenthood.

During Interconception, the time of conception, it is important to provide additional intensive interventions for women, particularly for those who have had a previous pregnancy with an adverse outcome.

Statistically, it is estimated that almost half of all pregnancies are unplanned, and consequently, many couples are not afforded the opportunity to plan their pre-conception or Interconception health as they might have wished. However, the same essential advice and assistance can significantly reduce, alleviate or avoid possible adverse consequences as the customer addresses and embraces the changes taking place during the various stages of their pregnancy.

The pharmacist has the opportunity and is equipped to initiate health-screening services; provide promotions outlining pre-conception care; outline changes in this care once the customer becomes pregnant; liaise with the prescribing doctor if necessary; and provide a broad range of information, including Consumer Medicines Information (CMI) relating to medications that are safe or unsafe during specific stages.

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CONTINUING PROFESSIONAL DEVELOPMENT

It takes 100 days for an egg follicle to mature and up to 116 days for sperm to be produced.1 Both men’s and women’s pre-conception health is very important during these times: if there are infections, nutritional deficiencies, toxins or other contaminants in the body, the chance of producing healthy eggs, sperm and ultimately a healthy foetus, is greatly inhibited.

In order to minimise nutritional deficiencies in women, it is recommended that a pregnancy multivitamin containing adequate levels of essential nutrients, such as folic acid and iodine, be taken during the pre-conception period. Other supplements that might be useful include fish oils and probiotics. For men it is recommended that a paternal multivitamin, fish oil and a coenzyme Q10 be taken.2 Nutrient requirements increase during pregnancy. For example, in the first and second trimesters there is an increased requirement for zinc, iron, iodine, chromium, folic acid, all B-group vitamins, magnesium and omega-3 fatty acids. It is important to note that critical development occurs early in pregnancy.

The second and third trimesters (particularly the latter) are important for foetal growth and DNA synthesis, and it is therefore important to provide adequate nutrient intake during this period to support both mother and foetus. It is recommended that women continue to take the pregnancy multivitamin in a similar pattern to that followed during the pre-conception period.

saccharin); saturated fats; salt; margarine; soft drinks; high-sodium sparkling beverages; food additives, colours and preservatives; unpasteurised products, such as raw goat’s milk; and cow’s milk, which should be consumed in moderation.

The listeria bacteria can be potentially very dangerous for women while pregnant for if transmitted to the unborn child, it can lead to miscarriage, stillbirth or premature birth or can make a newborn baby very ill.2 Many foods that are at risk of this bacterium include soft cheeses (e.g., brie, camembert, ricotta, feta and blue cheese); cold meats; takeaway chicken; pâté; prepared or stored salads; soft serve ice-cream; raw chilled seafood, such as oysters and sashimi;

and smoked seafood, such as salmon and smoked oysters. It is also advisable to avoid raw or slightly cooked eggs as there is a risk of salmonella poisoning.

Coffee, tea and cola drinks all contain caffeine, which can have adverse effects.

Customers should be advised to limit their intake to three cups of coffee or five cups of tea per day. Guarana is a caffeine substance used in some energy drinks, such as Red Bull, V and Mother; these drinks are certainly not recommended during pregnancy.

It is important to avoid contact with all potential sources of contamination and infection, particularly soiled cat litter and dog faeces because these may habour toxoplasmosis, which can cause birth defects.

TIPS FOR HELPING RELIEVE MORNING-SICKNESS SYMPTOMS Eat dry toast before getting out of bed as it lifts blood-sugar levels.

Try having a light snack before going to bed.

Instead of eating three main meals a day, try eating more frequent, smaller meals that are high in carbohydrates, such as a banana.

Try cutting out fats from the diet while experiencing morning sickness.

Avoid strong odours and smoky places.

Keep the stomach partially full all day by snacking on dry biscuits between meals.

Ginger/seasick acupressure bands may be helpful.

Vitamin B6 and ginger supplements.

Taking 1 to 2 grams of dried gingerroot over the course of a day has been shown to relieve symptoms. Higher doses may cause thinning of the blood, stomach discomfort and heartburn, so should be avoided in pregnancy.5

Lactobacillus rhamnosus GG (LGG®) has been shown through research to help reduce the occurrence of atopic allergies, such as eczema, in the infant if taken by expectant mothers, particularly if taken in the third trimester of pregnancy and throughout breastfeeding.2

DIET and INFECTION AVOIDANCE Establishing a well-balanced diet is always important, but it is particularly so during pre-conception and Interconception. Research continues to reinforce the importance of good nutrition during this period and throughout pregnancy: for the body to function at an optimal level, it requires a much higher nutrient intake of certain micronutrients.2,3 High-quality protein, low glycemic index (GI) carbohydrates and beneficial fats in the correct ratios are essential.2 We can advise customers to reduce their intake of processed and refined foods as these often contain high amounts of fat, sugar and salt, while being low in nutrients.4 It is advisable to include fresh, organic whole foods whenever possible, and to store any cooked leftovers in the fridge to reheat and use within a day of cooking. Foods to limit or eliminate include artificial sweeteners (e.g., aspartame and

FISH The World Health Organization recommends that pregnant women should take at least 2.6 g of omega-3 essential fatty acids daily.

However, caution should be taken with either the supplements taken or the fish consumed.

There are two different types of fish-oil supplements: those made from the liver of the fish and those made from the body of the fish.

Fish oil made from the liver of the fish, such as cod-liver oil, contains retinol (a form of vitamin A) and should be avoided in pregnancy.

However, fish oil not from the liver of the fish contains docosahexaenoic acid (DHA) and is

important for the baby’s developing eyes and brain.5 There are also certain fish types that might have higher levels of mercury that can affect the unborn baby’s nervous system.

It is recommended to have two to three serves (one serve equals 150 g) per week of any fish or seafood except if mentioned below:

•• 1 serve per week of orange roughy (sea perch) or catfish and no other fish that fortnight, or •• 1 serve per fortnight of shark (flake) or billfish (swordfish/broadbill and marlin) and no other fish that fortnight.

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FOLATE Folate is a B vitamin that is extremely important in the pre-conception period and in early pregnancy as it helps to prevent neuraltube birth defects, such as spina bifida.

Folate requirements are much higher during pregnancy, so women are advised to take a 500 mcg supplement of folic acid daily for at least 1 month prior to pregnancy and for the first 3 months after conception.4,6-8 This is in addition to consuming foods rich in folate, including green leafy vegetables, legumes, citrus fruits, fortified breads, cereals and other grain products. It is also important that pregnant women are not lacking in other B-group vitamins as folate acid requires them for conversion.

Women who have a family history of neural-tube birth defects, spina bifida or cleft palate, or who are on anti-epilepsy medication, might require a higher level of supplementation.8

The occurrence of orofacial clefting can also be reduced by an elevated dose of folic acid.9 A study published in a Lancet report proved that folic-acid supplementation provided a 72% protective effect from neural-tube defects.10 A later study performed in Dublin concluded that increased demand for folate during pregnancy is due to an increase in the rate of folate catabolism, which peaks in the third trimester at the time of maximal foetal growth. The calculated recommended daily dietary allowances from these results and this study were 340 mcg of folic acid during the first trimester, 430 mcg during the second trimester and 540 mcg during the third trimester. These results provide a quantitative basis for the current debate on the appropriate recommended dietary allowance for folate in pregnant women.11

IRON Women of reproductive age are recommended to have 18 mg of iron a day, which increases to 2727 mg/day during pregnancy.4 Red meat is the best source of iron, but other sources include chicken, fish, green leafy vegetables, legumes and iron-enriched breakfast cereals.

The World Health Organization recommends a daily iron supplement of 30 mg to 60 mg as prophylaxis for iron deficiency during pregnancy.12 A study by Cogswell et al showed a significantly lower incidence of infants with low birth weight with the mother taking an iron supplement.12 It is often difficult to intake adequate iron through diet alone and a pregnancy multivitamin containing iron can help.

IODINE Iodine is a trace element required for thyroid hormone production and is essential during pregnancy. Maternal thyroxine production increases by 50% to support the requirements of both mother and foetus. Initially, the foetus is solely reliant on the mother for the thyroid hormone; even when the foetus produces its own thyroid hormone, it is still reliant on the mother for its source of iodine.

The total recommended daily intake is 220 mcg. While Daniel Glinoer14 suggests that iodine prophylaxis should be given systemically to women during pregnancy,

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another study concludes that there is not a single ‘correct’ answer and that there are subgroups for which the general recommendation is not appropriate.3 An example is women with established thyroid disorders.

Iodine deficiency has been shown to be linked to alternations of neurological, psychological and intellectual development of the child during both gestation and the postnatal period.14 A supplement before pregnancy can help to ensure adequate levels.

Sources of iodine include seafood, table salt and bread, but as discussed in previous sections, there are other concerns relating to seafood and salt consumption during pregnancy and therefore a multivitamin with iodine is recommended.

CALCIUM Women do not actually require any additional dietary intake of calcium during pregnancy.

They should, however, ensure that they get the recommended daily intake of calcium for their age: 1300 mg/day for 14- to 18-yearolds or 1000 mg/day for 19- to 50-year-olds.

A glass of milk, a 200 g tub of yogurt, a 40 g slice of cheese or a 90 g can of salmon with bones each provides approximately 300 mg of calcium. The foetus needs plenty of calcium to develop its skeleton, especially during the last 3 months of pregnancy.18

WEIGHT and EXERCISE Weight is frequently part of the pre-pregnancy discussion and consideration because it can impact both on the pregnancy and the general ability to conceive. Underweight women are at risk of pre-term delivery, whereas overweight women may be at risk of adverse pregnancy complications, such as miscarriage, foetal abnormalities, high blood pressure, pre-eclampsia and significant complications during labour with a higher chance of caesarean section.8 The average weight gain during pregnancy is between 10 and 13 kg, equating to a weekly gain of 300 grams.7 Being fit and active prior to falling pregnant will assist in managing the physical changes that pregnancy and motherhood bring. Women will be better able to carry the extra weight gained and may experience fewer symptoms, such as sleeping difficulties, fatigue and backache. In general, pregnant women should avoid heavy lifting, scuba diving, parachuting, waterskiing, martial arts, gymnastics and horse riding as well as becoming overheated during exercise.

Activities that women find particularly beneficial during pregnancy include walking, swimming, yoga and Pilates.

CONTINUING PROFESSIONAL DEVELOPMENT

Women planning a pregnancy should also perform regular pelvic-floor exercises.

Pelvic-floor exercises are designed to strengthen the muscles of the pelvic floor by actively tightening them and lifting them at intervals. Hormonal changes, the added weight of the baby during pregnancy and childbirth can all contribute to the weakening of the pelvic floor. Having a strong pelvic floor can provide protection against incontinence.4 Early commencement of pelvic-floor exercises will assist with good bladder control during the pregnancy and afterwards.

OTHER PRE-PREGNANCY HEALTH CHECKS OR SCREENINGS It is recommended that pre-pregnancy health protocols include (but may not be limited to) the following:

•• Pap tests – recommended every •• •• •• ••

••

••

2 years and are safe to have during early pregnancy.

Breast checks.

Sexually transmitted infections tests.

Dental checks – X-rays are not recommended for pregnant women.

Medical conditions – may affect pregnancy and include high blood pressure, asthma, thyroid disorders, diabetes, epilepsy, anaemia, kidney problems, and heart or liver disease. Also, if necessary, consider seeing a physiotherapist, chiropractor or osteopath if there are any underlying back injuries or conditions that may affect the pregnancy or the birth of the baby.12 Some gynaecological conditions that might affect conception or cause concern during pregnancy include: fibroids, polycystic ovarian syndrome, pelvic inflammatory disease, endometriosis, cervical or uterine surgery, or more than three previous miscarriages.8 Medicines – includes those prescribed by a doctor or naturopath and those purchased over the counter from a pharmacy, a health-food shop or a supermarket. The pharmacist has a key role here to advise what is safe to take and make recommendations to the prescribing doctor.

Mental health – women with a diagnosed mental illness will need to talk to their medical team or psychiatrist about how to manage their illness during pregnancy, the birth and afterwards.

LIFESTYLE CONSIDERATIONS Pregnancy and childbirth can be a very stressful time and can add to other pre-existing stresses. Relationships, work, career, housing and financial security can all play a role in heightening the levels of stress. Customers may have feelings of being overwhelmed, anxious or in need of assistance.8

“Pregnancy and childbirth can be a very stressful time and can add to other pre-existing stresses. Relationships, work, career, housing and financial security can all play a role in heightening the levels of stress.”

It is strongly advised to limit alcohol if planning to become pregnant. Large amounts of alcohol, particularly in the first few months of pregnancy, can lead to physical or mental abnormalities in the baby as well as growth retardation. Alcohol intake can also affect sperm count in men.8 Smoking cigarettes and passive smoking have been proven to be harmful to the unborn baby, to be associated with infertility in men and women, and to increase chances of miscarriage. Smoking in pregnancy also affects the size and the long-term health of the baby. If planning a pregnancy, partners should also avoid recreational drugs as they can be harmful. Drugs such as marijuana and anabolic steroids may also affect men’s sex drive and sperm count.8

VACCINATIONS Pregnant women can become quite sick with the flu and are at risk of complications.

The influenza vaccination during pregnancy is therefore recommended and is also highly effective in protecting babies against flu in the first 6 months of life.8,15 Rubella (German measles) is normally a mild viral disease that sometimes produces no symptoms at all; however, infection during the first 20 weeks of pregnancy can result in severe abnormalities in an unborn baby, including developmental delay, congenital cataracts (blindness), enlarged liver or spleen, or death.8 Immunisation is contraindicated in pregnancy, but is recommended postpartum to protect future pregnancies against rubella infection and its consequences.

Chicken pox in very early pregnancy or close to the baby’s due date can cause infection in the baby, miscarriage or possible abnormalities. Infection is common in childhood and a vaccination is now available, but pregnancy should be avoided for 3 months after immunisation.8 The vaccination for diphtheria, tetanus and pertussis is safe to use during pregnancy; however, it is recommended in the pre-conception or postpartum phase.15,16 The hepatitis B vaccination

is recommended on the National Immunisation Program Schedule as the only vaccine given at birth, followed by another three doses at 2, 4 and 6 months of age.15,16

MONEY MATTERS The government provides allowances, paid as parental-leave payments, through the Department of Human Services for up to 18 weeks (to the primary carer and as long as the taxable income is less than $150,000 per annum). A parental-leave payment is also available for partners for 2 weeks after the baby is born.17 Parents may also be entitled to other benefits, such as a family tax benefit, rental assistance, childcare assistance and a Health Care Card, depending on income and assets. All enquires can be answered at Centrelink.17 There are a few local government and non-government organisations that specialise in providing women and child maternal healthcare services and financial support, including Mookai Rosie Bi-Bayan in Queensland. A helpful website to find other locations or support groups focusing on Indigenous health is www.healthinfonet.ecu.edu.au/.

Pharmacists therefore have a pivotal role with an increasing potential to assist customers in this very important stage of pre-conception planning and Interconception care. Even with the landscape of the pharmacy we can help mothers- or fathers-to-be by the thoughtful location of products and reading material of interest, including baby CPR and child health nurse services. The initiative of presenting educational talks relating to teething and asthma or other areas of potential concern can greatly assist parents to deal effectively with incidences when they occur.

In addition to maintaining current knowledge about all medication, the pharmacist must remain mindful that no medicine, either conventional or complementary, should be taken during pregnancy or breastfeeding unless the benefit outweighs the potential risks to the mother and infant.6

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CONTINUING PROFESSIONAL DEVELOPMENT

ASSESSMENT QUESTIONS Question 1.

Which sentence is the most correct? a. Alcohol intake does not affect sperm count in men. b. An ideal lunch for a pregnant woman consists of a sandwich with deli ham, brie cheese, a slightly undercooked egg and lettuce. c. Both men and women’s pre-conception health is very important and if during that time there are infections, nutritional deficiencies, toxins or other contaminants in the body, the chance of producing healthy eggs, sperm and therefore a healthy foetus, is greatly reduced. d. Pap smears are safe during pregnancy.

Question 2.

What is the recommended (RDI) amount of iron for a pregnant woman by the World Health Organization? a. 18 mg/day b. 30–60 mg/day c. 27 mg/day d. There is not an exact amount recommended

Question 3.

What is the recommended dose of folate supplementation for a healthy pregnant woman with nil known family-history problems in previous pregnancies currently in Australia? a. Don’t take any supplements, but increase folate-rich foods, including green leafy vegetables, legumes, citrus fruits, fortified breads, cereals and other grain products. b. Take a 500 mcg supplement of folic acid for at least 1 month prior to pregnancy and for the first 3 months after conception. c. Take a 340 mcg supplement of folic acid during the first trimester, 430 mcg during the second trimester and 540 mcg during the third trimester. d. Take a 500 mcg supplement of folic acid for at least 3 months prior to pregnancy and for the first 3 months after conception.

Question 4.

4. Which vaccination is the only vaccination recommended to have during pregnancy by the National Immunisation Program Schedule? a. Diphtheria, tetanus and pertussis vaccine b. Rubella vaccine c. Hepatitis B vaccine d. Influenza vaccine

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

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REFERENCES 1 George L. The importance of preconception care.

New Zealand Journal of Natural Medicine; (4) [Internet]. 2013 Dec 20 [cited 2014 Mar 31]. Available from: http://www.naturalmedicine.net.nz/womenshealth/the-importance-of-preconception-care/ 2 Metagentics. Pregnancy care [pamphlet]. Brisbane: Health World; 2011.

3 Mackerras D, Eastman C. Estimating the iodine supplementation level to recommend for pregnant and breastfeeding women in Australia. MJA. 2012 Aug 20;197:238-242. doi: 10.5694/mja12.10220.

4 Hailes J. Jean Hailes for women’s Health [Internet]. [updated 2014 Feb 10; cited 2014 Feb 28]. Available from: www.jeanhailes.org.au 5 The Royal Women’s Hospital. Herbal and traditional medicines in pregnancy [Internet]. 2013 June [cited 2014 Feb 28]. Available from: https:// thewomens.r.worldssl.net/images/uploads/factsheets/Herbal-traditional-medicines-in-pregnancy.pdf 6 Sansom LN, editor. Australian pharmaceutical formulary and handbook. 22nd ed. Canberra: Pharmaceutical Society of Australia; 2012 [cited 2014 Feb 28].

7 Johnson & Johnson Professional & Educational Services. The inside story – your pregnancy diary [pamphlet]. Ultimo: Johnson & Johnson Pacific; 2007.

8 The Royal Women’s Hospital. Preparing for a healthy pregnancy [Internet]. Victoria [cited 2014 Feb 28]. Available from: https://www.thewomens. org.au/health-information/pregnancy-and-birth/ preparing-for-pregnancy/a-healthy-start 9 Czeizel A. Primary prevention of neural-tube defects and some other major congenital abnormalities – Recommendations for the appropriate use of folic acid during pregnancy. Foundation for the Community Control of Hereditary Disease. Paediatric Drugs. 2000 Nov;2(6):437-48.

10 Wald N, Sneedon J, Densem J, Frost C, Stone R. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. Lancet.

1991 July 20;338(8760):131-37.

11 Higgins J, Quinlivan E, Mcpartlin J, Scott J, Weir D, Darling M. The relationship between increased folate catabolism and the increased requirement for folate in pregnancy. British Journal of Obstetrics and Gynaecology. 2000 Sept;107:1149-54.

12 Cogswell M, Parvanta I, Ickes L, Yip R, Bittenham G. Iron supplementation during pregnancy, anaemia, and birth weight: a randomized controlled trial. Am J Clin Nutr. 2003;78:773-81.

13 Milman N, Bergholt T, Eriksen L, Byg K, Gradual N, Pedersen P, et al. Iron prophylaxis during pregnancy – How much iron is needed? A randomized doseresponse study of 20-80 mg ferrous iron daily in pregnant women. Acta Obsete Gynecol Scand. 200; 84:238-47.

14 Glinoer D. The importance of iodine nutrition during pregnancy. Public Health Nutrition. 10(12A):154246. doi: 10.1017/S1368980007360886. 2007 15 Australian Government Department of Health and Ageing Immunise Australia Program. Australian immunisation handbook. 10th ed. 2013 [cited 2013 Mar 17]. Available from: http://www.immunise. health.gov.au/internet/immunise/publishing.nsf/ Content/Handbook 16 Rossi S. Australian medicines handbook [monograph online]. Adelaide: Australian Medicines Handbook; 2014 [cited 2014 Mar 31].

17 The Royal Women’s Hospital. Money matters [Internet]. Victoria [cited 2014 Feb 28]. Available from: https://www.thewomens.org.au/healthinformation/pregnancy-and-birth/preparing-forpregnancy/money-matters 18 The National Institutes of Health (NIH) Osteoporosis and Related Bone Diseases. Pregnancy, breastfeeding and bone health [Internet]. 2012 Jan [cited 2014 Apr 28]. Available from: http://www. niams.nih.gov/Health_Info/Bone/Bone_Health/ Pregnancy/default.asp

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Professional review

A sensitive topic:

Incontinence

BY VICTORIA SCHULTZ Bsc (USQ); BPharm (JCu) Pharmacist

In 2010 the Continence Foundation of Australia reported that 4.2 million Australians over the age of 15 years living in the community have suffered with urinary incontinence and 1.3 million have faecal incontinence.

“The social interactions and physical activities that are limited by incontinence are obvious, but it is also a condition that has been associated with impaired emotional and psychological wellbeing.”

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The health-care system expenditure to manage incontinence in 2010 was $271 million and expenditure in the future is only expected to increase. Approaching patients regarding delicate health issues is a hurdle for all health professionals and incontinence is no exception. To maintain continence— either faecal or urinary—there must be a balance between the forces that retain urine and faeces, and the expulsive forces.

Many factors lead to urinary incontinence, thus creating five groups: stress, urge, overflow, functional and mixed. The social interactions and physical activities that are limited by incontinence are obvious, but it is also a condition that has been associated with impaired emotional and psychological wellbeing, impaired sexual relationships and a doubled risk of admission to a nursing home.1

Professional review

“ Approaching patients regarding delicate health issues is a hurdle for all health professionals and incontinence is no exception.”

In community pharmacy we see a diverse group of patients who may suffer from incontinence. Often the topic is avoided as many people believe it is a natural process of ageing and buy incontinence aids to manage the issue. Incontinence is not just embarrassing and socially isolating, but it can also lead to perineal rash, pressure ulcers and urinary tract infections. These effects may lead patients to seek treatment, but how to treat urinary leakage itself is often an unasked question during counselling.

The Royal Australian College of General Practitioners (RACGP) does not recommend screening the general population for incontinence, but instead suggests taking the approach of screening at-risk groups during routine appointments. This approach provides a suitable tool in the community pharmacy as identifying patients at risk in the community allows for targeted questioning.

Females, the elderly, menopausal women

and obese patients form part of the at-risk group who might warrant a closer assessment when requesting items that may suggest they have incontinence. Easily identifiable at-risk patients are those who present for certain prescriptions, request urinary tract infection medicaments or purchase incontinence aids.

Approaching patients in the pharmacy regarding a sensitive topic is difficult and every patient is different. An example of a more sensitive approach to a woman purchasing hormone replacement therapy (HRT) might be: ‘During menopause some women experience bladder control problems.

Have you had any issues with leaking urine?’

This approach can also be applied to other conditions. An opportunity presents itself every time a patient collects a prescription as many prescription medications can contribute to incontinence. Beginning the conversation with, ‘This medication can cause urinary incontinence. Are you having any issues with urinary leakage?’, can initiate a conversation with the pharmacist or the doctor at the patient’s next visit. Drug classes that can cause or aggravate incontinence include:2

•• Diuretics, selective serotonin reuptake inhibitors (SSRIs), and cholinergic and anticholinesterase agents: urge incontinence.

•• Selective alpha-adrenergic blockers and angiotensin-converting enzyme (ACE) inhibitors: stress incontinence.

•• Anticholinergic agents, verapamil, pseudoephedrine, opioids and many psychotropic medications: overflow incontinence.

•• Psychotropic medications, analgesics and antihypertensives: functional incontinence.

If uncomfortable or time poor, providing a fact sheet on incontinence and pelvic-floor exercises to at-risk patients could be an opportunity to stimulate questions regarding a sensitive topic (see http://www.betterhealth. vic.gov.au/bhcv2/bhcpdf.nsf/ByPDF/Pelvic_ floor/$File/Pelvic_floor.pdf).

Patients taking medications that might be causing or worsening their condition should be referred to their doctor to discuss the possibility of ceasing or replacing the offending medications.

For patients suspected of suffering with urinary incontinence or enquiring about bladder leakage, a bladder diary (see http:// www.continence.org.au/data/files/Factsheets/ bladderdiary.pdf) would be beneficial to fill in and take to their doctor to discuss.

Treatment will depend on the type of incontinence; however, treatment can only begin when a patient acknowledges their condition. A survey conducted in GP waiting rooms revealed that only 30% of patients with urinary incontinence had spoken to a health professional about it.2 Patient education by community pharmacists is still important even in this age of technology and ‘Dr Google’; in fact, it is perhaps even more important now than ever considering the ‘informed’ notions that patients get from the internet.

Every day in practice we need to educate customers to ask the pharmacist for advice.

It’s a challenging job, but remember that we are promoting ‘Ask your pharmacist’!

REFERENCES 1. C Dumoulin & J Hay-Smith, ‘Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women’, Cochrane Database of Systematic Reviews, issue 1, 2010, art. no.: CD005654. doi: 10.1002/14651858.CD005654.pub2. Available online: http://onlinelibrary.wiley.com/doi/10.1002/14651858.

CD005654.pub2/full.

2. National Prescribing Service, NPS News: Managing urinary incontinence in primary care, issue 66, Dec. 2009. Available online: http://www.nps.org.au/publications/healthprofessional/nps-news/2009/nps-news-66-managing-urinary-incontinence-in-primary-care.

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professional review

Managing the mother load

BROUGHT TO YOU BY

Pregnancy and childbirth are two of the major life events associated with urinary incontinence, which is why the Continence Foundation of Australia chose maternity as its major theme for 2014.

The Continence Foundation’s 2014 special project, Pelvic floor awareness in pregnancy, childbirth and beyond, aims to make an impact on the number of women who are unnecessarily putting up with urinary incontinence after childbirth.

Eighty per cent of the 4.2 million Australians affected by urinary incontinence are women, with problems arising primarily after childbirth and menopause1.

Once women have had a baby, they have a one in three chance of developing urinary incontinence2. Unfortunately, many women accept this as normal, when in fact it’s preventable and treatable in the majority of cases.

The Foundation’s special project is delivering a number of initiatives, principally targeting the two key players midwives and expectant mothers.

For expectant mothers, a range of new resources will be launched during World Continence Week (June 23 – 29).

They include The Pregnancy Guide booklet and the Pregnancy Pelvic Floor Plan smartphone app (available from Google Play and iTunes). The Pregnancy Guide will also be included in the Mother to Be Bounty Bags, and is now available from the Continence Foundation of Australia.

The Continence Foundation is also conducting a national education program for midwives (on the impact of pregnancy and childbirth on pelvic floor dysfunction) in the lead-up to World Continence Week. In addition, the Foundation has developed an online

course for midwives, in collaboration with the Australian College of Midwives, also to be launched during World Continence Week.

The national campaign, Managing the mother load, will be officially launched during World Continence Week. The campaign will have a broader focus about the lifelong prevention and management of urinary incontinence, targeting mothers of all ages and health professionals.

The Continence Foundation’s project manager and health promotion officer Samantha Scoble said the campaign urged women of all ages to prioritise their pelvic floor health by incorporating pelvic floor exercises into their daily routine and engaging in pelvic floor-safe activities.

She said incontinence or fear of leakage could have a profound impact on a woman’s wellbeing, affecting everyday activities, such as social outings, work life and exercise.

“It can also impact on relationships and intimacy because of embarrassment or shame,” she said.

One of the biggest challenges for the Continence Foundation is getting people to seek treatment in the first place, given 70 per cent of people won’t even discuss the problem with their GP. “We know women are much more likely to talk to their pharmacist when they’re having problems,” she said.

While talking to their customers, pharmacists could aim to establish the duration and extent of the customer’s incontinence

“Incontinence or fear of leakage can have a profound impact on a woman’s wellbeing, affecting everyday activities, such as social outings, work life and exercise.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

and inquire about its impact on their day-today activities. They should also find out if the customer has consulted a GP, physiotherapist or attended a continence clinic.

Customers can locate their local continence service or specialist by phoning the free National Continence Helpline (1800 33 00 66), which is staffed by continence nurse advisors 8am-8pm Monday to Friday.

(People from ethnic backgrounds are able to access the Helpline by using the Telephone Interpreter Service on 131 450, or refer to the Continence Foundation’s translated web pages and resources at www.continence.org.au/other-languages.)

Customers can also be encouraged to take part in the Foundation’s online forum at continence.org.au/forum, where they can share their problems and receive support from others.

Pharmacists, along with other health professionals, can order resources, such as The Pregnancy Guide and any other of the Foundation’s many booklets, posters, flyers, pamphlets and fact sheets, from the Helpline or directly from the website (www.continence.org.au).

“It’s incredibly important that we have the support of health professionals in a range of disciplines so women hear the message from many sources. We rely on their reinforcing our key messages.”

The National Continence Helpline (1800 33 00 66) is staffed 8am-8pm Monday to Friday by continence nurse advisors who provide advice, referrals and resources to consumers and health professionals. Further information is available at www.continence.org.au.

REFERENCES 1. Deloitte Access Economics, The economic impact of incontinence in Australia, 2011 2. Newman, D. et al. Continence Promotion: Prevention, education and organisation, 2005.

3. Chiarelli P, Brown WJ, McElduff P. Leaking urine: prevalence and associated risk factors in Australian women. Neurol Urodyn 1999; 18: 567-77.

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16

Professional review

Right Advice is Key

BROUGHT TO YOU BY

To Helping Better Manage Incontinence

Dr Penny Adams GP and popular media presenter

Dr Penny Adams is a practicing GP on Sydney’s North Shore, and sees many patients ‘self diagnosing’ and subsequently trying to manage their incontinence. Dr Adams believes that pharmacists play an integral part in helping patients select continence products that fit properly and provide both appropriate absorbency levels and skin protection.

“Patients need to discuss their problem openly and seek a medical diagnosis of the underlying condition causing the incontinence with their GP,” she said.

“Following this, they should go straight into their local pharmacy for advice on appropriate product selection to give them peace-of-mind during any prescribed treatment or beyond as they seek to resume and enjoy everyday activities like golf or bowls,” Dr Adams added.

“Clearly pharmacies play a critical role in supporting their customers throughout

Despite its prevalence, incontinence remains a difficult topic for people to talk about even to their pharmacist or a GP. The right advice and right products are the keys to managing the condition so a person can get on with everyday life and continue enjoying usual activities.

their individual journey,” said Dr Adams.

However, the reality is there is no ‘one-size-fits-all’ approach to product selection for incontinence — different customers have different needs. The first step for pharmacies is to ensure their product range reflects this need.

The second most important aspect of advice is on the topic of maintaining skin health and skin integrity. Independent scientific evidence shows that incontinence and long-term continence pad use is associated with skin complications in nearly 43%1 of people living with incontinence.

These problems include skin irritation, reddening, itching and Incontinence Associated Dermatitis (IAD).

It’s well established that compromised skin health places people at risk of infection, reduced mobility, longer healing times and poorer health outcomes. Dr Adams believes

the key is helping customers choose from a wide selection of products with different styles, sizes, and absorbency levels, coupled with skin protection to help reduce skin irritation associated with incontinence and long-term pad use.

Finally, if the customer is seeking another level of assurance and advice, pharmacists can always refer them to The Continence Foundation of Australia’s Helpline which is a dedicated service staffed by continence nurse advisors who provide free advice, referrals and resources to consumers and healthcare professionals.

Contact National Continence Helpline (1800 33 00 66).

REFERENCES 1 Continence Foundation of Australia Fact Sheet circa 2011.

Incontinence: A Growing Problem

Dr Penny Adams’ tips for incontinence management

• Approximately 4.8 million Australians aged 15 or over live with incontinence and the majority (97.3%) live at home1.

Skin irritation, reddening, itching and Incontinence Associated Dermatitis (IAD) are all common effects associated with incontinence and long-term pad use.

• By the year 2030, the incidence of incontinence is estimated to increase to more than 6 million people, representing a staggering 27% of the population aged 15 and over1.

Tell customers to:

• In terms of prevalence, incontinence affects more Australians than asthma and anxiety disorders1, but it remains a social taboo and is rarely talked about.

• choose products that are the appropriate style, size and absorbency level for their needs • maintain a healthy skin pH • use barrier products that are zinc oxide free as they are less likely to interfere with pad absorbency • minimise the use of highly alkaline soaps.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

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18

Professional review

Neuropathic pain

BY Margaret Robinson B.Pharm.Hons, Dip Comp Sci – AM Pharmacy Guild of Australia

What is neuropathic pain?

Neuropathic pain is the pain associated with peripheral neuropathy as a result of various conditions, the most common being diabetes, although other conditions such as postherpetic and trigeminal neuralgia are also associated with significant neuropathic pain. It can often be more disabling than the underlying nerve damage from the neuropathic condition.11 It is caused by a disruption of the signalling system to the brain as a result of nerve damage and this nerve activity is perceived as pain.1 There are guidelines that exist for the effective treatment of neuropathic pain and emphasise the importance of medication efficacy, patient comorbidities, potential side effects and drug interactions, abuse potential, and cost when considering a medication for the treatment of neuropathic pain.2,3,4,5

Diabetes damages nerves, which causes pain, a distinct type of pain.

Diabetic foot

Treatment of neuropathic pain A variety of drugs have been used to treat neuropathic pain including traditional analgesics such as opiates and tramadol but also antidepressants and antiepileptic drugs. The antiepileptics and antidepressant drugs that are used have actions that help in neuropathic pain independent of their mainstream mechanisms of action.

This review will focus on drugs used as first-choice in diabetic neuropathy.

Current evidence-based recommendations for treatment of neuropathic pain 2,3,4,5 Choice of therapy

Diabetic neuropathy

Postherpetic neuralgia

Trigeminal neuralgia

First choice

Duloxetine Gabapentin Pregabalin TCAs Venlafaxine

TCAs Gabapentin Pregabalin 5% lignocaine patch

Carbamazepine Oxycarbazepine

Second choice

Tramadol Opioids

Tramadol Opioids

Baclofen Lamotrigine

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

Professional review Tricyclic antidepressants – TCAs (amitriptyline, dothiepin, doxepin, imipramine, nortriptyline) Australian, European and Canadian guidelines recommend that TCAs be considered as firstline treatment for both diabetic neuropathy and post-herpetic neuralgia.2,3,4,5 They have been found effective for pain in both depressed and non-depressed patients. The advantages of TCAs include their effect on common comorbidities such as insomnia and depression.5 They are inexpensive and dosed once daily.5 Anticholinergic side effects occur frequently and may be dose limiting. These include dry mouth and eyes, urinary retention, excess sedation, orthostatic hypotension, constipation, and blurry vision.5 Starting at a lower dose and titrating very slowly may reduce these side effects.5 Rare, but serious side effects include decreased seizure threshold and cardiac toxicity.5 Due to reports of tachycardia, myocardial infarction, and sudden cardiac death (at doses greater than 100 mg per day) the Neuropathic Pain Special Interest Group (a global group) recommends a baseline echocardiogram for patients over 40 years of age and avoiding TCAs in patients at risk for sudden cardiac death or with a history of cardiovascular disease.6 TCAs have a high risk of mortality in an overdose and should be avoided in patients at risk for suicide attempts.5 In elderly patients, TCAs can cause confusion problems and increase the risk of falls.5 A review of placebo controlled trials that included patients with a variety of neuropathic pain conditions concluded that TCAs were more effective than placebo.7 This review also compared one TCA to another and found there was no significant difference in efficacy among TCAs.

Serotonin-noradrenaline reuptake inhibitors (duloxetine, venlafaxine) Duloxetine has only been studied in diabetic neuropathy.5 The typical starting dose of duloxetine is 20 to 30 mg daily, which can be increased in 20 mg or 30 mg increments every week up to 60 mg daily.5 Initial treatment at 60 mg daily is associated with more nausea and doses higher than 60 mg daily have not consistently shown additional benefit in clinical trials.5 The same dose is effective for treating depression, anxiety, and neuropathic pain, which makes duloxetine useful in patients with these comorbidities.5 Duloxetine is typically well tolerated and

“Neuropathic pain is caused by a disruption of the signalling system to the brain as a result of nerve damage and this nerve activity is perceived as pain.”

is not associated with the anticholinergic side effects that often limit the use of TCAs; however, nausea is a common side effect.

This typically improves over time and is less likely when the drug is initiated at a lower dose (30 mg daily). A trial of 4 weeks at the maximum dose is considered adequate.5 Venlafaxine is initiated at a dose of 37.5 mg daily or twice daily and can be titrated by 37.5 to 75 mg each week as tolerated.5 The maximum dose is 225 mg per day. A trial of 4 to 6 weeks at a dose of at least 150 mg per day is necessary to assess the benefit of venlafaxine.5 Electrocardiogram abnormalities were reported in 5% of patients treated with venlafaxine in one clinical trial.6 Elevated blood pressure and heart rate have also been reported with gastrointestinal side effects being the most common.6

Antiepileptics (gabapentin, pregabalin)

Gabapentin Clinical trials have shown positive results for the treatment of postherpetic neuralgia but there are mixed results for the treatment of painful diabetic neuropathy.6 Gabapentin can be initiated at doses of 100 to 300 mg at bedtime or 100 to 300 mg three times daily.6 The dose should be titrated by 100 to 300 mg every 3 to 7 days as tolerated to a maximum dose of 3600 mg per day.6 The usual effective dose is 1800 mg to 3600 mg per day, which may take several weeks to achieve6. Because of the slow dose titration, an adequate trial may take more than 2 months. Sedation is the most common dose-limiting side effect and is minimised by initiating with a lower dose and titrating more gradually.5 Somnolence and dizziness are the most common side effects, and can often be managed by a slow titration5.

The elderly are more prone to these side effects and gabapentin may increase the risk of falls and worsen cognitive impairment in this patient population.

Pregabalin The efficacy of pregabalin has been established in randomised controlled trials for the treatment of painful diabetic neuropathy and postherpetic neuralgia.5 Some trials in these conditions have also shown negative results.

Pregabalin is initiated at a dose of 50 mg three times daily or 75 mg twice daily.5 The total daily dose can be titrated in increments of 150 mg every 3 to 7 days as tolerated to a maximum dose of 600 mg per day. However, doses greater than 300 mg have not consistently shown additional benefit for the treatment of neuropathic pain conditions.5 A lower initial dose and slower taper may help minimise sedation. Pregabalin has a faster tolerable titration than does gabapentin and twice daily rather than three times per day dosing. Pregabalin has minimal drug interactions and no hepatic metabolism.

It can help with comorbidities such as insomnia and anxiety.5 The side effects associated with pregabalin also appear to be similar to those associated with gabapentin, including: sedation, oedema, dizziness, and weight gain, and occur more frequently at higher doses.5

Conclusion Primary prevention with early diagnosis, exclusion of underlying causes and good glycaemic control, coupled with appropriate lifestyle changes, will delay progression and the development of complications associated with diabetic neuropathy and subsequent pain.2 The current evidence supports the use of tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs such as venlafaxine and duloxetine), gabapentin, pregabalin, and secondarily tramadol, morphine and oxycodone.2

references 1. Freynhagen R, Bennett MI. Diagnosis and management of neuropathic pain. BMJ 2009;339:b3002 2. Votrubec M, Thong I. Neuropathic pain - a management update. Aust Fam Physician. 2013;42(3):92-7.

3. Attal N, Cruccu G, Baron R. et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2009 revision. Eur J Neurol 2010;9 4. Moulin DE, Clark AJ, Gilron I. Canadian Pain Society. et al Pharmacological management of chronic neuropathic pain - consensus statement and guidelines from the Canadian Pain Society. Pain Res Manag 2007;12(1):13–21 5. O’Connor AB, Dworkin RH. Treatment of neuropathic pain: an overview of recent guidelines. Am J Med 2009;122(10, Suppl):S22-S32 6. Dworkin RH, O’Connor AB, Backonja M. et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 2007;132(3):237–251 7. Saarto T, Wiffen PJ. Antidepressants for neuropathic pain. Cochrane Database Syst Rev 2007;(4):CD005454 GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

19

20

TRAINING AND EDUCATION

Pain. It’s something we’d all like to do without ...but have to learn to live with or at least manage the impact it has on our health and everyday life.

MAXIGESIC is a world-first specific combination analgesic invented by Hartley Atkinson, Australian born pharmacologist and founder of AFT Pharmaceuticals. It is the first Paracetamol/ Ibuprofen combination analgesic to be registered in Australia, and also has license agreements in over 40 countries around the world. MAXIGESIC is a patented combination of Paracetamol (500mg) and Ibuprofen (150mg), two tried and trusted active ingredients that work together synergistically on different pathways to relieve pain and reduce fever and inflammation.

What types of pain is MAXIGESIC® indicated for?

MAXIGESIC is indicated for the temporary relief of a wide range of pain including headache, migraine headache, tension headache, period pain, backache, muscular pain, toothache, dental pain, arthritis, rheumatic pain, tennis elbow, sinus pain, sore throat, and aches and pains associated with colds and flu.

Does MAXIGESIC® provide effective pain relief?

MAXIGESIC is clinically proven to provide more effective pain relief than either Paracetamol or Ibuprofen alone1. These results were achieved in a double blind, parallel group study of the post-operative pain relief of 135 patients after the removal of 1-4 wisdom teeth¹ - a scenario which involves both pain and inflammation in patients.

The trial compared Paracetamol 4000mg, Ibuprofen 1200mg and MAXIGESIC in four divided daily doses, monitoring the patients for 48 hours following their surgery. The trial results showed that MAXIGESIC provides pain relief that is 32.3% more effective than Paracetamol and 35.8% more effective than Ibuprofen1#.

Is there Codeine in MAXIGESIC®?

Is MAXIGESIC® suitable for children?

No, there is no codeine in MAXIGESIC. Codeine is often used to amplify the effect of pain relief in other combination pain relief products, but as a member of the opiate family it has the potential for misuse. Though codeinebased combination analgesics are popular in Australia, health authorities around the world have expressed their concern about this issue and for this reason MAXIGESIC was specifically formulated without codeine.

MAXIGESIC is NOT recommended for children under 12 years of age.

Why is the specific Paracetamol/ Ibuprofen combination in MAXIGESIC important?

The combination of 500mg Paracetamol and 150mg Ibuprofen, taken as the maximum recommended daily dose of 2 tablets, 4 times per day, delivers the maximum recommended OTC dose of 4000mg Paracetamol and 1200mg Ibuprofen. The simple dosage regimen for MAXIGESIC provides better pain relief than either Paracetamol or Ibuprofen alone1 and it will aid consumer compliance when taking a recommended course of Paracetamol and Ibuprofen.

How should patients take MAXIGESIC®?

Patients should take 1-2 tablets with a large glass of water, repeating the dose every 6 hours, as required, up to a maximum of 8 tablets in 24 hours (Paracetamol 4000mg/ day and Ibuprofen 1200mg/day). MAXIGESIC should be taken for only a few days at a time for adults, or 48 hours for children and adolescents aged 12-18 years, unless advised otherwise by a doctor. MAXIGESIC should not be combined with any other Paracetamol or Ibuprofen containing medicines.

When should patients NOT take MAXIGESIC®?

MAXIGESIC should NOT be taken by patients if they:

•• Have asthma •• Have a stomach ulcer or other stomach disorders

•• Have impaired kidney function, impaired liver function or heart problems

•• Are allergic to Ibuprofen, Aspirin, Paracetamol or other anti-inflammatory medicines •• Are pregnant or breastfeeding •• Are a heavy drinker MAXIGESIC is a Pharmacist Only medicine (Schedule 3). You can find more detailed product information at the new MAXIGESIC website www.maxigesic.com.au, including the full Product Information if you are thinking of recommending it to customers. Access to the full website is restricted to healthcare professionals only and is password protected – please follow the on-screen instructions to gain access if you don’t have the password.

Alternatively contact your local AFT representative directly or call the AFT Pharmaceuticals Sydney office on (02) 9420 0420.

#Expressed as the mean time adjusted VAS pain scores 48 hours post-op at rest.

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.

Maxigesic® film coated tablets (Paracetamol 500mg and Ibuprofen 150mg; 10s, 16s and 30s) are a Pharmacist Only (S3) Medicine for the temporary relief of pain and reduction of fever. The usual dosage for Adults and Children over 12 years is 1-2 tablets taken every 6 hours with a full glass of water, as required, up to a maximum of 8 tablets in 24 hours. Patients should not take more than 8 tablets in a 24 hour period. Incorrect use can be harmful. Do not use in children under 12 years or if patients have kidney disease. Do not use if patients have asthma or a stomach ulcer. Do not combine with any other Paracetamol or Ibuprofen containing medicines. AFT Pharmaceuticals Pty Ltd, Sydney. Patent No. 2005260243.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

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22

Business Profile

Paper-Pak

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

Paper-Pak emerged from the Detmold Group in 1989 with a vision to provide a complete packaging solution to retailers in the form of carry bags, wrapping papers and tissue.

More than two decades on, Paper-Pak has grown to become the premier paper packaging company in Australia, servicing a wide variety of markets. We recently had the pleasure to speak with Nicholas Hoskins, General Manager of Paper-Pak, to find out a little more about the company and its growing footprint within the pharmacy industry.

Editor: Paper-Pak is a member of the Detmold Packaging Group – Can you give us a bit more background into Paper-Pak as a company?

Nick: Paper-Pak is a dynamic sales and marketing company directly servicing the retail, government, winery, and telecommunications industries with printed paper carry bags, wrapping papers, gift bags and tissue. Our quality and outstanding product range is unsurpassed in the market and our investment in new product development enables us to set standards others aspire to.

“More than two decades on, Paper-Pak has grown to become the premier paper packaging company in Australia, servicing a wide variety of markets.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

Paper-Pak is a member of the Detmold Group, a privately owned global packaging company head-quartered in South Australia and operated by the Detmold family. The Detmold Group has over 65 years of experience in the sustainable manufacture of paper and board products and has factories located in Jakarta, Indonesia; Heshan and Shanghai, China; Ho Chi Minh City, Vietnam; Johannesburg, South Africa; as well as Adelaide, Australia. Paper-Pak has warehousing and distribution networks in all states in Australia, with Adelaide housing the largest warehousing facility.

Business Profile

Q2 Editor: Can you tell us about your partnership with the pharmacy industry in Australia, how this started and how it has evolved?

Q3 Editor: What is Paper-Pak’s competitive advantage in the market and what do you believe are the key elements behind the continued growth and success of Paper-Pak?

Nick: Detmold Packaging has been producing bags for the pharmacy industry since its inception. Our relationship with The Pharmacy Guild in particular dates back over 17 years, when we began producing Gold Cross branded pharmacy bags. The bags are designed to fit pharmacy size requirements for scripts, refrigerated medications and other pharmacy items.

Nick: Paper-Pak’s competitive advantage lies in our extensive product range which is unrivalled by opposition companies in the market and provides customers with numerous choices and solutions. We invest a significant amount of resources into new product development to bring our clients the latest in colours, designs, textures and materials.

We don’t follow trends — we set them.

As the needs of pharmacists have changed, so has our product range.

The recent introduction of a paper carry bag to the range offers a sound alternative to plastic bags as legislation banning plastic bags in Australian states and territories increases. Continued innovation in the area of online products is also a focus for Paper-Pak.

We have achieved outstanding success through focusing on new product innovation, which has led to our expansion into new market segments. Backed by Detmold’s innovation and design centre — LaunchPad — we have the ability to bring new product concepts to life in just one day.

The quality of Paper-Pak’s product also sets us apart in the market, with full control of our manufacturing facilities and quality procedures both here and overseas, our customers can be assured they will be delivered a high quality product consistently.

“The quality of PaperPak’s product also sets us apart in the market, with full control of our manufacturing facilities and quality procedures both here and overseas, our customers can be assured they will be delivered a high quality product consistently.”

Q4 Editor: Tell us a bit more about your product range and service offering that allows you to stand out from your competitors.

Nick: Our extensive range includes carry bags, gift bags, club and counter rolls, flat bags, tissue paper, adhesive labels, boxes, and wrapping paper dispensers. We service the wine industry with bottle bags and printed wraps, and we have an online mailing range including satchels and boxes. Additionally we offer an extensive range of Christmas-specific packaging, supporting the theming and spirit that exists in the retail environment at that time of the year.

Custom printing of our products is a key service offering that enables companies to extend their brand footprint to include the packaging they offer. Aside from completing the marketing story, it is another way of advertising a business once the customer leaves a store.

Paper products are our core business and we therefore work with all stakeholders to offer them environmentally sound packaging solutions that are biodegradable, compostable, recyclable, re-fillable, and re-useable to support our environment.

Q5 Editor: Finally, what are the specific goals and objectives for the Paper-Pak business in 2014 and beyond? How do you hope to achieve these?

Nick: Paper-Pak is striving to continue providing superior quality products for our customers to achieve the growth that they seek. We will do this by providing excellent customer service, focusing on quality and value, and working with our customers to achieve innovative solutions for their packaging needs.

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Professional review

Chronic Pain: An Opportunity for Pharmacists to Make a Difference Chronic pain poses an enormous economic and human cost to Australia. It is a common reason people seek medical help, yet it remains one of the most neglected and poorly understood areas of healthcare.

A great deal of new knowledge has emerged in recent years about the role of the brain and the nervous system — neuroplasticity — in influencing our experience of pain.

More recent studies reveal the influence of genetics on a person’s response to pain stimuli, including the likelihood of developing chronic pain; however, this new research has been slow to translate into education and training for health professionals and treatment options for patients.

In Australia — the first country in the world to develop a National Pain Strategy (2010) — one in five Australians, including children and adolescents, will suffer chronic pain in their lifetime. This prevalence rises to one in three people aged over 65. In 2007,

“80 per cent of Australians living with chronic pain are missing out on treatment that could improve their health and quality of life.”

3.2 million Australians (1.4 million males and 1.7 million females) were living with chronic pain and this is projected to increase to 5.0 million by 2050.1,2 Yet, 80 per cent of Australians living with chronic pain are missing out on treatment that could improve their health and quality of life and this is especially so in regional and remote areas. Wait times for treatment at a multidisciplinary pain clinic at a public hospital are frequently more than a year, and sometimes up to three years.3,4 As chronic pain is largely invisible, sufferers often feel misunderstood and stigmatised. Left untreated, chronic pain can lead to severe disability affecting all areas of a person’s life including their relationships with family and friends.

Rates of depression are 20 per cent higher among people with chronic pain than the rest of the population, and up to one in five suicides in Australia are related to physical health problems.5,6 One in nine people with severe or very severe pain have some interference with work, and in people of working age, back problems and arthritis account for 40 per cent of forced retirements. For people with chronic pain on the Disability Support Pension, there is an average drop in income of 75 to 80 per cent.7

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The cost of chronic pain to the Australian economy is estimated at $34 billion per annum, making it the nation’s third most costly health problem. It has been estimated that half of the costs to the health system of $7 billion could be saved by providing effective and timely treatment, as recommended in the National Pain Strategy.2 The Strategy recommends a framework which would ensure access to best-practice pain management at all levels of the health system — including most importantly at the primary care and community level — ensuring more timely intervention and a more appropriate chronic condition management model for chronic pain.

Although some states have taken steps to implement the plan, including the establishment of 13 new regional pain centres, and new services being slowly developed in primary care through the Medicare Local network, national leadership is needed to ensure a more coordinated response.

Unfortunately, in many arms of the health system, chronic pain is still regarded as a symptom and not properly recognised as a chronic medical condition in its own right.

While acute pain is usually short-term and can in most cases be effectively treated, chronic pain — that is pain that continues

for at least three months, or way beyond the expected time of healing — is far more complex and difficult to treat.8 Medication alone is not the answer, nor is any single treatment effective for most people. A multidisciplinary approach, which addresses the complex physical, psychological and environmental or social factors involved is needed.

Typically such treatment is available only in a specialist pain clinic; however, as the National Pain Strategy recommends, there are opportunities to develop professional networks in primary care to bring together multidisciplinary teams including a GP and practice nurse, physiotherapist, clinical psychologist, and a pharmacist to help people in pain.

While pharmacists play a key role in advising and helping to manage quality use of medicines, they are also able to provide

“A multidisciplinary approach, which addresses the complex physical, psychological and environmental or social factors involved is needed.”

education about the nature and types of pain and effective self-management techniques.

of psycho-social support and education,” said Ms McSwan.

Community pharmacists are well placed to help facilitate such networks, especially in areas where there is a shortage of GPs and there are good examples of this being done in some areas.

Alex Page, a community pharmacist from Broken Hill, devotes two days a week to the Maa Maa Aboriginal Health Service, as part of a multidisciplinary team, seeing patients who would rarely consult a pharmacist. Mr Page also routinely conducts Home Medicines Reviews and provides patient education.

Queensland pharmacist, Joyce McSwan, has developed such networks in Mackay and the Gold Coast.

“The fact that medicines are only 30 per cent effective for pain conditions was a motivator for me. I felt quite limited by that, and I knew there was much more that could be done in my role as a pharmacist, in terms

There is an enormous need for more pharmacists to take up the challenge of better healthcare for chronic pain, and make a difference. Painaustralia is keen to hear from any pharmacist with an interest in pain, and is able to help source suitable education materials and support.

References 1. Blyth F, March L, Brnabic A, Jorm L, Williamson M, Cousins M (2001) Chronic pain in Australia: a prevalence study. Pain 89(2-3): 127-34 2. MBF Foundation (2007) The high price of pain: the economic impact of persistent pain in Australia. Report conducted by Access Economics in collaboration with the Pain Management Research Institute – The University of Sydney/Royal North Shore Hospital 3. National Pain Strategy (2010) 4. Australian Pain Society (2010) Waiting in Pain. Report.

5. ABS (2011) 4841.0 Facts at your fingertips: Health: Characteristics of bodily pain in Australia, http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4841.0Chapter12011 6. Commonwealth of Australia (2006) National Activities in Suicide Bereavement Project, Department of Health and Ageing 7. Schofield et al. (2012) Quantifying the Productivity impacts of poor health and health interventions Health economics, University Sydney 8. Cousins MJ & Gallagher RM (2011) Fast Facts: Chronic and Cancer Pain

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down to business

Bounce Back from PBS Reforms: the Business Case for Soft Skills Product

Programs

People

BY vanessa lontos Community Pharmacist and Consultant

Foundation

Soft skills

Clinical knowledge and technical skills

Soft skills are increasingly becoming the hard skills of today’s workforce. It’s just not enough to be highly trained in technical skills without developing the softer, interpersonal and relationship-building skills that help people to communicate and collaborate effectively.

These people skills are more critical than ever as businesses struggle to find meaningful ways to remain competitive and be productive.

At a time when pharmacy businesses need to adapt and change, recognition of the growing body of evidence that soft skills improve business success has never been timelier.

Research now shows that soft skills deliver very substantial benefits to a business’s bottom line. The first group of bottom-line improvements relates to benefiting employees by improving productivity and job satisfaction, reducing the costs associated with staff turnover, and reducing the waste and failure associated with poor soft skills.1 The second key improvement is the increase of revenue through increased customer loyalty and satisfaction.

Over the past few months there has been increasing discussion on the real impact of a reduction of pharmaceutical dispensing revenue on the everyday local community pharmacy. A report from the Pharmacy Guild of Australia suggests that pharmacy gross profits will fall by an average of $90,000

“Soft skills are increasingly becoming the hard skills of today’s workforce.”

in 2014–15 due to price disclosure. As a result, many pharmacies are being forced to reduce staff to remain viable. This is not only affecting hardworking pharmacy professionals, but also, importantly, the patients they serve.2 Before trying to quickly change your business, reduce your staff numbers to do more with less and cut services due to a lack of resources, let’s examine why refining the soft skills of your staff could actually be the most beneficial next step.

In his book The heart of change, John Kotter explores real-life stories of how people change their organisations. Specifically, he talks about how emotions such as anger, false pride, pessimism, arrogance, panic, cynicism, exhaustion, insecurity and anxiety all undermine an effort for change. He goes on to say that the emotions that facilitate change include faith, trust, optimism, urgency, reality-based pride, passion, excitement, hope and enthusiasm. According to Mr Kotter, change is hard because ‘in order to make any transformation successful, you must change more than just the structure and operations of an organisation – you need to change people’s behaviour, and that’s never easy.’3 Navigating and responding to changes to the external business environment and the ever-increasing demands of competition requires soft-skill strength first. Nothing can change if the people you do have are feeling

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overwhelmed, confused and uncertain.

Build them up first and the business will build on their shoulders.

As a pharmacy owner I attempted all sorts of operational changes to bounce back from PBS reforms. I trialled extended trading hours, changing wholesalers, doing a mini shop refit, reducing staff numbers and even returning early from maternity leave (rushing home to breastfeed wasn’t fun!). I felt productive and proactive and I hoped that my business would weather the storm, my staff would come along for the ride and the business would continue to grow. What I didn’t realise was that while attention to operations and systems was important, focusing on my staff needed to be my first priority. I discovered that managing change required a new level of personal awareness, a specific mindset and a whole new set of skills and behaviours.

Regardless of the business model you are running, the one common element to all pharmacy businesses is people, and the success of your business is determined by the ability of your people to perform well, work together and to do so in a consistent manner—not to mention their ability to connect with your patients in a way that is warm and friendly, builds relationships and inspires return business. In the past, soft skills have been considered a nice

down to business

“Research now shows that soft skills deliver very substantial benefits to a business’s bottom line.”

addition to a staff member’s technical capability. In today’s world where there is so much choice, it’s often the soft skills that differentiate and set your pharmacy apart from everyone else.

Pharmacists need to know about medication and be knowledgeable in giving health-related advice. Dentists need to know how to fill cavities.

Doctors need to provide accurate diagnoses and good clinical care. Beyond these technical skills, though, which health professional do you choose? Most likely the one that is warm and answers your questions, that communicates openly and makes you feel like your concerns are important to them.

Soft skills in healthcare businesses that are particularly important include emotional intelligence, motivation, innovation, a strong work ethic, good communication and collaboration skills, social skills and cultural awareness.

Research into the soft skill of emotional intelligence in business success is particularly interesting and has grown over the past 20 years. The Harvard Business Review (HBR), one of the most prestigious sources of business best practice, has released several articles on emotional intelligence. Its 1997 article on emotional intelligence by psychologist and author Daniel Goleman ranks as the most requested article ever.

“In order to make any transformation successful, you must change more than just the structure and operations of an organisation – you need to change people’s behaviour, and that’s never easy.”

This popularity led the HBR to re-examine the data on emotional intelligence again in 2003.

‘In hard times the soft stuff often goes away.

But emotional intelligence, it turns out, isn’t so soft. If emotional obliviousness jeopardises your ability to perform, fend off aggressors, or be compassionate in a crisis, no amount of attention to the bottom line will protect your career. Emotional intelligence isn’t a luxury you can dispense with in tough times, it’s a basic tool that, deployed with finesse, is the key to professional success.’4

Pharmacy businesses are in essence comprised of three core areas: people, products and programs. Only through establishing a foundational soft-skills set in our people can we build a business that maintains the core elements irrespective of what challenge may present. After all, it is the interaction and relationships established between the people working within the pharmacy and the people visiting the pharmacy that ultimately sells products and programs.

References 1 http://www.isaca.org.

2 Pharmacy Guild of Australia, Employment expectations report, April 2014.

3 JP Kotter, The heart of change, Harvard Business School Press, Boston, 2002, p. 178.

4 J Freedman, ‘The business case for emotional intelligence’, White Paper, available from: www.6seconds.org.

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MYSTERY SHOPPER

Protocols – It’s our job to ask HELEN STRACHAN Pharmacy Practice Officer The Pharmacy Guild of Australia, Queensland Branch.

During a recent training session where I was presenting on the mystery-shopping program and protocols, a pharmacy assistant asked me a very valid question: ‘How do you overcome the customer who gets cranky because we have to ask them questions?’ Before I could answer, the lady beside her intervened and answered: ‘Easy. I just say I am asking because I care about you and your health.’ This led me to think, could it really be that simple?

After a lot of thinking I came to the conclusion that not only does it depend on the type of customer we serve, but on the confidence of the pharmacy assistant to carry out their responsibility to ask these questions because it’s our job to ask. I have outlined below some common barriers we face when it comes to protocol questioning:

•• The customer knew what they wanted.

•• They seemed agitated through their •• •• •• •• •• •• •• •• •• ••

body language.

They said they’ve had it before and knew all about it.

The customer was in a rush.

The pharmacy was very busy with customers waiting.

We were short-staffed.

There is a demand for the product.

The customer only wanted a common S2 medicine.

The customer buys the product from us regularly.

They asked for the medication by name.

The customer had been asked the questions before.

Customers feel interrogated.

I’m certain that some of these sound quite familiar, but have you ever stopped and thought, ‘What makes me feel comfortable asking some customers all of the right questions, yet not others?’ Customers need to be educated on why we question them; it is the law in Australia that medications are categorised and scheduled according to their risk of causing harm and the way they are made available to the public. Pharmacy assistants are employed to support the pharmacist and require a lot of product knowledge and training. Our roles play a very important part and should be taken seriously, especially when it comes to dealing with someone’s health care.

How can we adopt a new approach towards our protocols?

As I mentioned above, I think confidence plays a large role in this and dealing with customers can be quite demanding at times.

However, there is a reason why there is a counter between pharmacy staff and the customer. Imagine if a pharmacist just

“Explain to the customer why you need to ask them questions and learn how to incorporate the protocols into a conversation.”

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handed out a medication without a script or asking questions? It would just never happen. Over-the-counter medications should be treated with the same respect.

What approach can we take towards how we use our protocols to overcome the barriers we face?

•• Be confident—take ownership of your role.

•• Take your role seriously.

•• Remember that you are employed to carry out these responsibilities.

•• Explain to the customer why you need to ask them questions.

•• Learn how to incorporate the protocols into a conversation.

•• Read your store’s policies and procedures

•• •• •• •• ••

•• ••

relating to dealing with customers, customer service and referring to the pharmacist.

Serve every customer as if you were serving a family member or a friend.

Hold training sessions based around protocols.

Be consistent.

Utilise your mystery-shopping score to identify areas requiring improvement.

Print out the ‘What, Stop, Go’, ‘Ask, Assess, Advise’ or ‘Carer’ protocols and display them for all staff to refer to.

Train new staff thoroughly.

Treat every customer as a mystery shopper.

MYSTERY SHOPPER

The mystery-shopping program captures the interaction between the staff member and customer (mystery shopper) with the score based around the use of protocol questions in relation to pharmacy medicine and pharmacist-only medicine requests/symptoms.

Let’s look at a direct-product request for a pharmacist-only medicine, Nurofen Plus, by a customer. Working the protocols into a general conversation will eliminate a robotic approach of questioning the customer.

Good morning, how can I help you?

I would like some Nurofen Plus, please.

Just to make sure we get you the right product, where is your pain?

“Customers need to be educated on why we question them; it is the law in Australia that medications are categorised and scheduled according to their risk of causing harm.”

I have a really bad headache.

The real-life example below, provided by a work colleague, demonstrates the benefits, through consistently asking protocol questions:

I’m sorry to hear that.

For how long have you had your headache?

I woke up with it this morning.

Are these common for you?

I very rarely get headaches.

I asked an elderly gentleman after his regular request for Panamax all of the protocol questions— e.g., ‘Have you had this one before?’ ‘Yes, yes’, was the reply. When asked what were the actual symptoms, he said, ‘My doctor has told me to take it every day to help thin my blood.’

Somewhere along the line he got Panamax confused with Astrix; hence, he was getting no protection to help prevent his arteries from clotting.

That’s good, and is Nurofen Plus what you have successfully used before if you’ve had a headache?

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Yes, it has worked for me.

I know you just want to get some pain relief, but I just need to let the pharmacist know about any other medicines you take. Do you take any other medications?

I don’t take any other medicines.

Okay, I’ll let the pharmacist know that.

Just one last question: do you have any stomach problems or asthma or any condition relating to blood pressure?

No, I am usually quite healthy.

Thank you for the information.

The pharmacist shouldn’t be too long.

The above is just one scenario; however, by adopting this conversational approach you can gather the information you need without the customer really knowing how much you are gaining from the interaction or feeling interrogated.

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DOWN TO BUSINESS

Pharmacy Ownership: Buying & Selling What’s going on and what to look out for Peter Saccasan FACP FCA CTA Director of Pharmacy Services, RSM Bird Cameron Chartered Accountants

The pharmacy market continues to see strong prices being paid for pharmacy businesses across all states. At a recent dinner in Melbourne, Medici Capital made the observation that capitalisation rates continue to remain strong with a median capitalisation rate below 17%.

Strong prices mean that buyers need to be wary. At the same time, vendors should be aware of what the consequences are of the sale.

The purchasing issues Pharmacy buyers are quick to find out that the purchase price is determined by applying a return on investment rate to the profit of the target pharmacy. The differences of opinion are therefore limited to 2 areas – what is an acceptable return on investment (ROI) and what is the actual return or profit?

ROI The ROI reflects a number of things.

These will include:

•• each buyer’s propensity for risk – are you

there would be no variance as to what this is.

It is interesting the creativity that surfaces when owners are asked to present their profit and loss statement to support the profits that are stated as being the return the new owner will receive. My experience tells me that the buyer needs to be very thorough in determining what it is they are actually buying.

Some issues I have seen include the following: 1. Financial statements where the gross margin is extremely low, are apparently due to a “bookkeeping error” that has omitted sales or understated stock.

willing to take on more or less risk?

•• the impact of supply and demand for businesses •• the opportunities or risks that the purchaser sees with the business and with the industry.

2. Wages apparently have deliberately been 25% too high and the new owner will be able to run the business on less staff.

As noted earlier, the median ROI is below 17%.

An ROI of 18.18% represents 5.5 times profit; 16.67% represents 6 times profit. Bear in mind that most small businesses will sell on an ROI of usually between 20% and 50%. The lower the ROI, the higher the price. Because the ROI is very subjective, there is generally no right or wrong answer. There will just be a difference of opinion as what risk should be accepted and therefore how low an ROI the purchaser should accept.

4. Outgoings adjustments usually appear after the end of the financial year. What is the impact if they adjust out last year’s outgoings and don’t include this years?

3. The lease on the premises is about to run out and the rent will definitely be the same in the new lease — so we are told.

5. Methadone income is not included in the profit and loss statement but is included in the adjusted profit.

6. Franchise or group membership fees are considered as optional and therefore not a real expense.

What is the profit?

One would think that the actual return or profit of the business is a factual number and that

If the expenses of the pharmacy are understated or the income is overstated by just $20,000,

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then using an ROI of 17% overstates the price by $117,647, calculated by (20,000 / 0.17).

Outside impacts The further issue is the impact of items that are not in the profit and loss statement.

It is important to understand that the ROI model makes the assumption that the profit being capitalised is going to be earned forever. If there are events that will affect this profit in the short term, then these need to be considered.

These include:

•• the impact of PBS reform. This is not

•• •• •• ••

a maybe – there will be an impact. Has the profit been reduced for the likely impact on gross profit from the dispensary? the construction of a new shopping centre nearby that might draw customers away the recent opening of a large discount pharmacy nearby the recent loss of a nursing home customer the likelihood of a large rent increase.

The purchaser needs to do their homework, construct a profit statement that shows the return they will most likely achieve, and then determine a purchase price based on that adjusted profit. Buyers need to hold the line and not be swayed by higher bids where those buyers have a different risk appetite or perhaps have not properly factored in the risks. There are many issues to assess.

DOWN TO BUSINESS

“My experience tells me that the buyer needs to be very thorough in determining what it is they are actually buying.”

It is not a simple task and buyers should be willing to get the right level of advice to ensure that they don’t make a very costly mistake in paying too much for a pharmacy. If the bid price goes too high, walk away.

The exit strategy Why do you buy a business? There are many reasons but ultimately it is to sell it for a good price. Some key issues to consider when selling your pharmacy: 1. Pharmacies are no different to other assets — there are good times to sell and wrong times to sell.

2. Prepare the pharmacy for sale: a. Have a long lease term in place or left on your lease. b. Review your profit and loss statement thoroughly to make sure expenses are properly categorised. c. If there are unnecessary wages being paid, do something about it.

d. Know what your staff leave entitlements are — these will be a deduction from your sale price. e. Engage a broker and work on a sale information pack. Have that ready before you put the pharmacy on the market.

3. Because the sale price is a big number, make sure you know what the tax consequences are of selling: a. Are you eligible for the small business concessions? Amongst other things, you need to have net CGT assets of no more than $6m.

Sometimes this can be achieved with proper planning to give you access to more exemptions. b. What is your final tax liability?

c. Note that a sale occurs when you exchange contracts and not at settlement. So you need to get advice before you exchange.

4. Understand the cash flow of the sale: a. Is the money all going to the bank? b. Are there equipment or fitout leases to pay out? c. Do you have to put money into superannuation to minimise your tax and when do you need to do this? d. If you have tax to pay, is there cash left to do this?

Taking advice is worthwhile As you can see, both sides of the pharmacy sale transaction have their tricks and traps.

The key is to be willing to get advice and then to take advice at the right time.

WE FORM A PHYSICAL BARRIER SCIENTIFICALLY PROVEN TO KEEP ACID IN THE STOMACH1,2 References: 1. Chevrel B. J Int Med Res 1980; 8(4): 300–2. 2. Lowe RC. GI Motility online 2006. Available at www.nature.com/gimo/contents/pt1/full/gimo54.html. Accessed 14/02/2013. Always read the label. Use only as directed. If symptoms persist see your healthcare professional. ® Gaviscon is a registered trademark of RB Australia.

44 Wharf Road, West Ryde, NSW 2114. RBGA8327/ITK/Strip. April 2014.

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TRAINING AND EDUCATION

FAB IRON Liquid Iron Helping customers get the right balance FAB IRON Liquid Iron is a great tasting liquid iron containing organic iron, vitamins and herbal extracts to help restore energy and overall health, delivering just the right amount of iron – not too much, not too little.

Female customers regularly request assistance when purchasing vitamin supplements to address particular concerns, with comments of ‘feeling constantly tired’ being one of the most familiar. Low iron levels can result in feelings of tiredness, fatigue and a general lack of energy.

Here are some great facts and figures about FAB IRON Liquid Iron to help when assisting your customers

Did you know women require up to 18mg of iron per day but most consume less than 10mg within their daily diet?

To help cover this shortfall, FAB IRON developed the iron range that delivers just the right amount of iron. FAB IRON Liquid Iron is the ideal daily iron supplement as it is easy to digest and absorb, and is gentle on the stomach. Each daily 10ml dose of FAB IRON Liquid Iron contains just 10mg of iron, plus energy boosting B group vitamins and Vitamin C to assist maximum absorption of iron.

Not too much, not too little – Iron consumption levels can make all the difference The inclusion of daily iron supplements can make all the difference to energy levels and assist when diet alone does not deliver adequate iron. But it is important to know that an overconsumption of iron can have negative effects. Excessive iron intake can lead to stomach irritation, nausea, constipation and bloating. Which is why FAB IRON supplements contain just 10mg of iron, the ideal amount and not too much.

as it does not need to be broken down and can be easily absorbed by the digestive tract.

The whole family can take FAB IRON Liquid Iron FAB IRON Liquid Iron is a simple and great tasting iron supplement for the whole family.

FAB IRON Liquid Iron is ideal for people who have problems swallowing tablets such as young children. FAB IRON Liquid Iron is also available in convenient single dose sachets which are ideal for people on the go.

FAB IRON Liquid tastes great FAB IRON Liquid Iron has a great fruity taste from a delicious blend of apple, beetroot and cherry juices. It also includes a mix of rose hip, chamomile, balm leaf, quack grass root and horsetail herb extracts.

Facts about low iron levels •• In fact, 70% of Australian women aged between 25 and 55 years have diets deficient in iron , with low iron levels considered the single most common cause of fatigue in women.

•• Factors which contribute to low iron levels include overconsumption of alcohol and caffeinated drinks, stress, regular exercise, menstruation, vegetarian or vegan lifestyle, pregnancy and breast feeding •• Initial symptoms of low iron levels and iron deficiency include:

– Dizziness – Hair loss – Brittle and thin nails

Customers to be aware of who may require iron supplements •• Women: Women have a higher iron requirement than men due to the extra demand caused by blood loss during menstruation

•• Pregnant and Breastfeeding women: Iron is a vital mineral during pregnancy and whilst breastfeeding. Developing babies are solely dependent on their mother’s supply

•• Children: Children who don’t get enough iron through their diet are at risk of developing iron deficiency. Iron is well known to play a crucial role in both physical and cognitive development during childhood

•• Teenagers: During puberty, the body’s iron requirements increase to cater for rapid growth, as well as for the loss of iron due to menstruation in teenage girls, and the considerable gains in bones and muscles in teenage boys

•• Vegetarians: Vegetarians are at high risk of being low in iron, as their diet requires almost twice as much dietary iron as non-vegetarians.

– Tiredness and fatigue – Lack of energy and stamina – Poor sleep

Not all iron supplements are the same

– Poor work and intellectual performance

One of the many benefits of FAB IRON Liquid Iron is that it contains an organic form of iron called ferrous gluconate. Ferrous gluconate is easily digested and absorbed, leaving little unabsorbed iron to enter the intestinal tract.

Unabsorbed iron passing through the intestinal tract can lead to negative effects. Iron is also more readily absorbed when it is in liquid form,

– Decreased immune function – Heightened sensitivity to the cold – Headaches – Loss of appetite – Feeling weak – Dark circles under eyes – Pale skin

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For more information about iron deficiencies, FAB IRON Liquid Iron or FAB IRON tablets and capsules, visit www.fabhealth.com.au

For long lasting dryness relief Aci-Jel® Restore is a specially designed vaginal moisturiser that contains soothing natural ingredients that provide long lasting relief of vaginal dryness caused by menopause and other hormonal changes.

✓ Soothes. ✓ Moisturisers. ✓ Relieves.

Available from pharmacies nationally.

www.acijel.com.au

Always read the label. Use only as directed. If symptoms persist see your healthcare professional. ®Registered trademark of Care Pharmaceuticals Pty Ltd. ABN 30 0009 200 604

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TRAINING AND EDUCATION

Little Coughs Calming the littlest one’s coughs with Ivy Leaf extract!

Finally, a cough syrup for the little ones that’s free of preservatives, artificial colours and flavours. Little Coughs is a new cough syrup specially developed to soothe coughs and chest congestion for children and the whole family.

Whether from playgroup or school, children are constantly exposed to an onslaught of coughs, colds and viruses. As their little bodies work to recover from their latest cold, coughing helps clear their lungs. Unfortunately, it also makes it difficult for them to sleep, making them constantly tired (and grumpy!).

Unlike many cough syrups for children, Little Coughs is suitable for children under the age of 6 years and can be given to children under the age of 2 years, after consultation with a doctor.

The Ivy Leaf extract in Little Coughs is an expectorant which helps thin and loosen mucus, eases throat and chest inflammation, while also reducing and calming coughing.

What is Ivy Leaf extract?

Ivy Leaf extract has been used for centuries as a medicinal herb for cough relief.

Clinical studies have found Ivy Leaf extract to be an effective and extremely well tolerated cough medicine and is recommended for the treatment of coughs in children.

Coughs and colds go hand in hand.

To help relieve other cold symptoms such as blocked noses, suggest the gentle saline solution in Children’s FESS Saline Nasal Spray and FESS Little Noses for newborns and babies.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

Without the worry of preservatives, artificial colours and flavours, Little Coughs makes looking after your child’s cough one less thing to worry about.

For more information about Little Coughs, visit www.littlecoughs.com.au

diabetes australia update

Type 2 Diabetes: the focus for this year’s National Diabetes Week in July By Diabetes Australia Over 1.7 million Australians have diabetes and 280 new cases develop every day in Australia. Eighty-five to ninety per cent of the epidemic is type 2 diabetes, and over 2 million Australians have pre-diabetes and are already at high risk of developing type 2 diabetes.

The good news is that we can prevent or delay this progression from pre-diabetes to type 2 diabetes through sustained lifestyle-change programs.

‘We have strong evidence that over half of cases of type 2 diabetes developing from pre-diabetes can be prevented through sustained lifestyle changes which combine healthy eating, increasing physical activity, and obtaining and maintaining a healthier weight’, said Diabetes Australia CEO, Professor Greg Johnson. ‘We have seen the state-wide implementation of a program in Victoria funded by the Victorian Government, the Life! program, which has now seen over 30,000 people access structured lifestyle change programs to prevent type 2 diabetes and we need a National Diabetes Prevention Program to take this powerful and proven prevention to a national scale.’

For those who do develop type 2 diabetes, most will need oral medications and/or insulin injections in addition to lifestyle changes to help manage their type 2 diabetes. Selfmonitoring and management is particularly important. Unfortunately, if type 2 diabetes is not well managed, it can lead to serious health complications, including heart attacks, strokes, kidney damage, blindness, limb amputations, serious anxiety, depression and more.

There are many different risk factors for type 2 diabetes and the more of these you have, the greater your risk:

•• If you are inactive •• If you smoke •• If someone in your family (mother, father, brother, sister) has type 2 diabetes

•• If you are overweight, obese or are carrying extra weight around your waist

•• If you have pre-diabetes •• If you have high blood pressure, abnormal blood fats (cholesterol) or cardiovascular disease •• If you are an Aboriginal person or a Torres Strait Islander •• If you are from another country (those at greater risk include people with backgrounds from the Pacific Islands, Southern Europe, the Middle East, Northern Africa and Southern Asia) •• If you have had diabetes during pregnancy (gestational diabetes).

To know your risk of developing type 2 diabetes, do the risk test at www.lifeprogram.org.au/online-test or call 13RISK (13 7475).

To know your risk of developing type 2 diabetes, do the risk test at www.lifeprogram.org.au/online-test

www.diabetesaustralia.com.au

or call 13RISK (13 7475).

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

35

36

ADVERTORIAL

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A Little Bit of Relief is a cooling, pain relief gel that comes in 2 convenient dispensers.

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

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

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

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

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A Little Bit of Relief is an easy to apply gel. Apply liberally to the affected area.

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A Little Bit of Relief has been formulated to be suitable for long term use, such as for the management of chronic pain.

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

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

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

Visit alittlebitofrelief.com for more information.

For pharmacy orders, contact Clear Sales Australia on 1800 640 043 or order direct from Symbion, Sigma or API.

TRAINING AND EDUCATION

Maintaining good nasal health now ...will help manage upcoming colds and flu symptoms Tips and advice from FESS®

New FESS® consumer research has found over half (54%1) of consumers felt they regularly suffered moderately severe nasal congestion, with 1 in 7 replying felt their nasal congestion significantly interfered with their daily activities. Regular use of FESS® saline nasal sprays can not only help reduce nasal congestion and relieve that ‘stuffed’ up feeling, it can also help prevent nasal symptoms by helping to maintain nasal health – this is especially important when a patient is suffering from a cold or flu.

“The nose and sinuses are an important part of the body’s immune system.

Nasal passages filter incoming air and are the front line defence and help provide protections against respiratory tract infections.

Nasal passages and sinuses are lined with cells which produce mucus to trap particles of bacteria, dust, and pollen; preventing them from reaching the lungs. This mucus is then moved to the back of the throat by tiny hairs called cilia. This is called mucociliary clearance.” explained ear, nose and throat surgeon Dr Larry Kalish.

FESS cold & flu season facts ®

• Did you know each year,

adults can expect to catch between 2 – 4 colds, and children between 6 – 10

• There are over 200 different known cold viruses • Over 80,000 Australians visit their GP suffering the flu each year References: 1 FESS Consumer Research Dec 2013, n=1011

“This system can become impaired if the mucous membrane becomes inflamed, and the mucous becomes thickened.

This can block the sinus outflow passages, resulting in a build-up of pressure behind it. Bacteria can take advantage of stagnant mucous and develop into a bacterial sinus infection. So an impaired mucociliary clearance system is often associated with ailments such as sinusitis, hayfever and bronchitis.” said Dr Kalish.

“Because saline sprays are natural, they can be used as often as necessary and are non-habit forming. They relieve and protect the nose; by clearing the nose and thinning nasal mucous. Saline sprays can also be used to supplement medication. They can be used before medicated nasal sprays such as steroids, antihistamines and decongestants to allow for better penetration and can be used to carry medications into the nose and sinuses.” said Dr Kalish. ”When I make a recommendation to a patient, I often start with recommending saline, and then move to further topical medications if required.”

“Reduced airflow can also significantly affect your overall quality of life.” said Dr Kalish Reduced airflow quality can also affect quality of sleep and lead to snoring; contribute to blocked ears, headaches, neck and back problems; and affect your ability to exercise.

FESS top tips for being prepared ahead of cold and flu season

pollutants, dust and allergens, and helps moisturise nasal passages.

•• Considered flu shots? A patient should talk to their pharmacist or GP for more information about this season’s flu shot and whether it is applicable for them or their family.

•• Fresh is best: One should make sure their diet is balanced and full of fresh vegetables and fruit.

•• Consider vitamin and mineral supplements: This is especially important if a person feels their diet may be lacking or are vegetarian

•• Stock the medical cupboard ahead of time: Always have a saline nasal spray on hand for when a cold sets in. Saline nasal sprays help to clean and clear a blocked nose, naturally.

Recovering from a cold?

•• Stay at home and rest.

•• Restore nasal health: Using a saline nasal spray to thin the thick cold induced mucous will make the mucous easier to clear from the system, and help to restore the health of one’s nose. ** It is important not to share nasal sprays as this can lead to the cross-infection of others

For more information about the FESS® product range, please visit www.fess.com.au

•• Good nasal health is important in preventing infection. Regular use of saline nasal sprays will keep your nose functioning effectively to support your body’s natural defences against colds.

FESS® Saline Nasal Sprays help guard against airborne bacteria, washes away GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

37

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

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

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

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

Dr Candy Tsouranis

Professor Charlie Benrimoj

Professor of Clinical Pharmacy, University of California San Fransisco

Head of School and Professor of Pharmacy Practice Graduate School of Health, University of Technology, Sydney

Earn CPD credits

Register online at

This activity has been accredited for 3.5 group 1 credits and 18 group 2 credits

blackmoresinstitute.org

An accredited educational event for pharmacists looking to learn about the quality use of complementary medicine in practice.

Pharmacy research shows that most of your patients use complementary medicines (CM) and would welcome advice about efficacy and safety. However, a lack of confidence in advising on CM is seen as a concern across the profession.

This CPD-accredited program has been specifically designed to address this need and to ensure that responsible, evidence-based CM education is available to support the development of pharmacy into a true healthcare destination.

The program will allow community pharmacists to: • Find out how CM can fit into your professional practice • Learn about a variety of clinical and primary care topics where CM can be a successful adjunct therapy • Take away an exclusive toolkit with valuable resource information to support your clinical practice

25 July - 26 July 2014 The Westin, Sydney

>>

Full program available at blackmoresinstitute.org

How confident are you when answering patient enquiries about complementary medicine?

Register for Blackmores Institute Symposium blackmoresinstitute.org

l

25 July - 26 July 2014

l

The Westin, Sydney

Day 1

Day 2

Keynote: Dr Candy Tsourounis

Keynote: Dr Charlie Teo MBBS FRACS

Drug/herb/nutrient interactions.

Day 2 topics:

Day 1 topics:

•

Common nutritional deficiencies & clinical guidelines for pharmacists

Evidence part 1: The state of CM evidence and where to find it

•

Herbal medicine for pharmacists

•

Safety issues when recommending CM

•

•

CM clinical interventions

Top disease states with case studies on common conditions and treatments

•

Evidence part 2: The big picture

•

•

Panel discussion: Mythbusters – busting popular misconceptions about CM

Implementing a CM service in community pharmacy

•

Panel discussion: Pharmacy model case studies and Q&A

•

The patient journey: One inspiring story from a crippling condition to good health

•

CM opportunities in pharmacy

•

To view the full program or learn more about our distinguished presenters visit blackmoresinstitute.org.

EARN Earn CPD credits Accreditation Number: A1407BM

3.5 group 1 credits & ____________ 18 group 2 credits

This activity has been accredited for 3.5 group 1 credits and 18 group 2 credits upon successful completion of all assessments during the event for inclusion on an individual pharmacist’s CPD Record.

At the completion of this symposium the pharmacist should be able to: • • • •

Discuss the potential role of complementary medicine as adjunct therapy for a range of conditions seen in pharmacy Explain how to implement a successful CM health service in pharmacy Discuss the evidence base for clinical interventions with complementary medicines List key counselling points, including dosing, contraindications and/or interactions for evidence-based CMs and how to apply to clinical practice

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

40

TRAINING AND EDUCATION

Product Education

Aci-Jel Restore

Rectogesic

Various conditions, medications, menopause and other hormonal changes can affect the vaginal ecosystem and lead to dryness, discomfort and irritation.

Many people experiencing ano-rectal symptoms such as burning pain, swelling, bleeding, discharge and itching assume they are a result of haemorrhoids, but they may be due to anal fissures.

Aci-Jel Restore is a specially designed vaginal moisturiser to relieve the symptoms and discomfort of vaginal dryness. It contains soothing natural ingredients to help replenish and restore moisture to the vaginal environment, increasing comfort and confidence.

Spasm of the inner sphincter muscle is the root cause of both haemorrhoids and anal fissures. 90% of anal fissures are caused by high sphincter pressure.

Long lasting vaginal moisturizer

Aci-Jel Restore is a water based, pH balanced lubricating gel formulated with plant extracts, chamomile and aloe vera. It helps to soothe minor irritations and itching and provides long lasting moisturizing relief from vaginal dryness.

Aci-Jel Restore can also be used as a lubricant before sexual intercourse and is suitable to use with latex condoms.

Haemorrhoids or anal fissures?

Rectogesic Ointment relaxes the sphincter spasm – The active ingredient in Rectogesic ointment , Glyceryl Trinitrate, has been clinically proven to relax the sphincter spasm which results in increased blood flow to the wound; reduced pain levels; accelerated wound healing; 60-80% of patients with anal fissures avoid surgery with subsequent courses.

For more information on Aci-Jel Restore Call 1800 788 870 or visit www.acijel.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

For more information on Rectogesic Call 1800 788 870 or visit www.rectogesic.com.au

42

down to business

HOW TO FIND AND RETAIN

High-quality employees IN YOUR HEALTHCARE ORGANISATION

Graham Howard Agency Owner, Frontline Health

The reputation of your healthcare organisation depends largely on the quality of your staff members. Attracting and retaining the best employees can be challenging in today’s competitive environment. The first step is finding high-quality candidates. Writing a great job advertisement will help you to attract the people who will fit in with your organisation.

Here are some ideas to help you ensure that your job descriptions are as effective as possible to attract the best candidates.

MAKE YOUR JOBS EASY TO FIND Many candidates search online for jobs, which means you have to make sure that your job advertisement is easy to find. As well as posting it in the right places, it is essential to use the right keywords in your job ad or it will likely get lost. Ensure the job title is included in the heading of the advertisement and that any other words or phrases that your candidates might use to search with are also mentioned in the body of the text. Popular search criteria include salary, full-time or part-time, and benefits, such as flexible working hours.

SELL YOUR ORGANISATION FROM THE BEGINNING Competition to attract the best candidates is fierce, so you need to make it clear why employees should want to work for your organisation. If you aren’t sure, you can ask your current employees why they like working for you.

BE SPECIFIC AND CLEAR ABOUT WHAT THE JOB ENTAILS Be wary of making bold claims about the role you are recruiting for. If your job description isn’t honest, the successful candidate might be disappointed when they start work. An honest job description and clear criteria can help ensure that the candidates who apply will be suited to your organisation.

Although writing an effective job ad will help to ensure that you have high-quality candidates applying for your roles, once you GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

find a candidate to hire there are a few things that you can do as an employer to make them feel comfortable within their new role.

Here are some ways that you can help your new healthcare employee settle into their role.

BE PREPARED ON THEIR FIRST DAY Make sure that everything your new employee needs is ready for them on their first day.

This can help reduce awkwardness and make them feel part of the team right from the start.

CREATE A WELCOMING ENVIRONMENT Let other staff members know that a new team member is starting and nominate one person or several people to be on hand to show them around, take them for lunch and answer any questions they might have.

CONSIDER COMPILING A WELCOME PACK OF INFORMATION This could include an overview of the organisation, its policies, ethos and philosophy and some guidelines for the role.

The first few days can be very overwhelming for new employees due to a lot of information to absorb, so having something they can take away and study at home might help prevent them feeling too overloaded at once.

GIVE THEM TIME It’s important to allow new employees time to orientate themselves and build their confidence, so try to avoid starting them off with a full workload. Co-workers and managers should also be aware of the need to set aside time to work with the new employee, answer their questions and provide them with advice and opportunities to learn hands-on skills.

Even if you are busy, like most people in the healthcare industry, it’s worth taking some time to write an effective job ad and to help your new employees settle in. The cost of high staff turnover and recruitment can be crippling to any organisation, so creating a positive first impression can make a big difference to the likelihood that your new employee will stay.

Clinically proven to tackle the pain of anal fissures

Rectogesic速 Ointment is the only non-prescription medication that is clinically proven to relieve the pain associated with anal fissures.

The unique active ingredient in Rectogesic Ointment, Glyceryl Trinitrate acts quickly to soothe the pain and relax the muscle spasm.

Rectogesic速 Ointment also assists with wound healing following haemorrhoid surgery.

For more information call 1800 788 870 or visit www.rectogesic.com.au Contains: Glyceryl Trinitrate 0.2%. Rectogesic速 is a pharmacist medicine only.

Always read the label. Use only as directed. If symptoms persist consult your healthcare professional. 速 Registered trademark of Care Pharmaceuticals Pty Ltd. ABN 30 009 200 604

44

GUILDCARE

Creating efficiency in pharmacy

BY ROMA CECERE General Manager – Strategic Business Performance, GuildCare

“GuildSmart allows managers to set profit generating goals for their pharmacy, track progress in realtime and maximise the pharmacy’s’ profitability by utilising opportunities as they happen.”

It is apparent that most community pharmacies in Australia are feeling the financial effects of the PBS reforms. One of GuildLink’s core strategies is to enhance sustainability of pharmacy.

GuildLink provide pharmacy with business tools and software solutions designed to optimise their front of shop and professional services by identifying opportunities with real-time insights.

Through GuildCare, pharmacists can identify patients who may be eligible for a professional service, whether it is a program within 5CPA, such as MedsCheck, or a patient service offered in pharmacy such as a Blood Pressure recording service. GuildCare works with the pharmacy’s dispensing software and triggers a prompt at dispense for patients that may meet the program criteria. This feature ensures busy pharmacists are spending less time analysing patients’ potential fit for a professional service and more time on where it matters — performing the patient service.

Patient Services are also a perfect way to gain patient loyalty to your pharmacy.

Most pharmacies conduct many patient services such as Baby Clinics, INR monitoring, and Lipid and Blood Pressure recording. Imagine the impact on the patient if you provide them with a personalised patient handout with a chart measuring their progress over a period of time rather than a ‘Post-It’ note with their figures for that day. Which pharmacy will the patient prefer to come back to? Through GuildCare, providing patients with additional care is a simple task that many of our subscribers are already utilising, with over 100,000 patient services cases delivered over the past year.

Expanding personalisation even further, visualise the patient experience in your pharmacy by providing programs that can

assist them with the use of their medicines and the impact this may have on their health and overall wellbeing. GuildCare recognises patients that are potentially non-adherent or are newly initiated on therapy.

Adherence programs are tailored to the needs of the molecule which means the pharmacist can provide a more specific service addressing the essentials to ensure patients improve their compliance. Our figures show that when a patient has been enrolled in one of GuildCare’s adherence programs their adherence increases by 1.5 to 2 additional scripts per year. Most of these programs are sponsored which means the pharmacy will be reimbursed for the additional time spent on counselling the patient.

Enhancing your pharmacy’s professional services offering and specialisation ensures patient loyalty; however, this is only one way to maximise your pharmacy’s potential — we recognise front of shop as the other.

GuildSmart offers a bespoke solution to maximise front of shop, by showcasing a pharmacy’s potential at the click of a button.

This program is perfect for pharmacy owners, managers and retail staff.

Smart pharmacies have already revolutionised the way they pursue their business goals. The software works with

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

pharmacies’ point of sale and GuildCare software to analyse available opportunities such as OTC generic conversion, companion products and GuildCare professional services.

GuildSmart allows managers to set profit generating goals for their pharmacy, track progress in real-time and maximise the pharmacy’s’ profitability by utilising opportunities as they happen. The software also recognises dead stock items from dispensary and front of shop, along with items that are marked incorrect GST. The ability to see what sales opportunities pharmacy staff have completed and which have been missed will provide managers with key insights into staff engagement and allocate appropriate key performance indicators.

In this crucial time, providing pharmacies with tools to enhance patient loyalty through personalised services and identifying ways to maximise the efficiency of front of shop is GuildLink’s ultimate goal.

If you would like to know more about our program offering, please contact John Daniells, National Account Manager, on jdaniells@guildlink.com.au.

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It also contains herbal extracts and energy boosting B group vitamins.

So get the taste for life with

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

Vitamin supplements should not replace a balanced diet. CHC 60028 10/13

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www.fabiron.com.au

46

BUSINESS PROFILE

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

Thomas Brown Shopfitters (TBS) opened its doors in December 1980 in a small factory at Mount Nebo, 25 km west of Brisbane, Queensland. Thomas Brown Shopfitters are specialists in pharmacy design and construct services, fitting out most banner-group pharmacies.

We recently spoke with Tom, the Director and Owner of TBS, to discuss a little about the company and its growing footprint within the pharmacy industry. Tom holds a number of industry positions, including the National Training Chair of the Australian Shop & Office Fitting Industry Association (ASOFIA):

•• Committee Member and Training Chair, State Division ASOFIA

•• Board Member, ASOFIA •• General Councillor, Queensland Master Builders Association

•• Member, Specialist Services Industry Reference Group, Construction Skills Queensland (CSQ) •• Former Board Member (12 years), Construction Training Queensland (CTQ).

Editor: Thomas Brown Shopfitters is a successful shopfitting business.

Can you give us a little background regarding the infancy and growth of your business?

to further prospects when Golden Casket Lotteries introduced its first corporate image in 1990. TBS became an approved installer of Golden Casket agencies shortly after.

We developed the fabrication side of the business to become the specialist pharmacy design and construct service that is widely sought after today, fitting out most bannergroup pharmacies.

Editor: What are the key elements behind the continued growth and success of TBS? Tom: Thomas Brown Shopfitters is recognised for its commitment to providing high levels of service and satisfaction to existing and potential clients alike. A point of difference was the setting up of a design office with a qualified designer and architect. TBS has continued to provide this service for clients and to generate further business. Reliability and quality has paid dividends for this growing business.

Tom: I initially managed, consulted, designed, constructed and installed all projects myself.

It was about 3 months before I sought to employ the first of my employees.

Editor: Can you tell us a little bit about your partnership with the pharmacy industry in Australia— how this started and has grown?

Primarily, initial projects were for clients that operated small businesses. As business grew, prospective clients began to contract Thomas Brown Shopfitters to design and fit-out their businesses. Originally these clients were newsagents and independent pharmacy owners. Over time, the order of natural progression developed Thomas Brown Shopfitters into a specialist shopfitting company.

Tom: Pharmacy groups Green Spot Chemists and Sunshine Pharmacies approached us in the early 1980s seeking quality shopfitting services, and, as banner groups evolved, TBS was approached by previous clients and also by new groups.

Early pharmacy projects for independent chemists and newsagency projects led

We feel privileged to have assisted clients with their first pharmacy and to watch many grow their businesses to have ownership in other pharmacies along with influential positions within the Pharmacy Guild and pharmacy-associated industries.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

Editor: Outside the specialist arena of pharmacies, what other industries/ businesses do you work with?

Tom: Thomas Brown Shopfitters have also been contracted for many varied commercial projects, including: training pharmacies; melanoma scan and laser rooms; hotel bars; private school specialist labs and uniform shops; university fit-outs and other professional offices; hair and beauty salons; boutique jewellers; ice-cream kiosks; coffee shops; and varied retail outlets.

We believe ‘no job is too small’ and all clients should be entitled to the same level of service and attention.

Editor: How has innovation and new technology helped your business growth and development?

Tom: With the introduction of design software such as AutoCAD and Revit to aid design and drafting and the use of CNC machines to aid precise manufacturing methods,

BUSINESS PROFILE

today’s preparation and manufactured items have raised the professional product outcomes available from our industry.

Editor: Finally, Tom, what are the specific goals and objectives for the TBS business in 2014 and beyond this?

How do you hope to achieve these?

Tom: Our industry sector has been decimated

by Chinese imports and it is an ongoing challenge for our business and our industry to strive to maintain our standard of quality when competing against an inferior, but cheaper, alternative. We strive to push the message home that we need to continue to train apprentices so that manufacturing can survive for the future of our Australian youth.

Above is a photo of Tom presenting the annual ASOFIA Phil Boron Memorial Award.Tom initiated this award following the unfortunate loss of Phil Boron, an ASOFIA national president who was also driven in the training and employment of apprentices for our industry.

“We developed the fabrication side of the business to become the specialist pharmacy design and construct service that is widely sought after today, fitting out most banner-group pharmacies.”

40 Webster Road Stafford QLD 4053

www.thomasbrownshopfitters.com.au

Tel: (07) 3356 8266 Email: info@thomasbrownshopfitters.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

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48

RETAIL FOCUS

The Need for Tighter Stock Control

BY SIMON HAMBRECHT

“What we need to be doing much better is putting elements in place to recover from the PBS reforms more quickly.”

Director of Pharmacy Essentials

By now you would have all realised the impact of the April reforms and will be wondering how you can squeeze more out of your business to maintain performance and profitability.

for Mother’s Day with a supplier. As the proposed order reached $10,000 of ‘desirable’ stock the team member thought it would be best to refer the order to the pharmacy owner.

One of the unfortunate things with Pharmaceutical Benefits Scheme (PBS) reform is that the impact is immediate! What we need to be doing much better is putting elements in place to recover from these reforms more quickly: having an ongoing focus on driving sales; reviewing what our teams are delivering in terms of sales; and examining one other major contributor—better stock management.

Before we go any further, it’s worth noting that this order was compiled on supplier recommendation and was nothing short of a hunch. There was no review of sales from last year, no assessment on return for such an investment and no consultation with the owner.

Coming from a corporate background in both retail and pharmacy, it truly amazes me how our industry (in general) still doesn’t test and measure every element of the business.

This requires not only having budgets in place for key areas, such as wages and stock, but also having budget reviews on a regular basis.

How did we compare to the budget?

In what areas did we exceed? How will this impact our profit and loss? How will we recover from this over spending? These are all questions that have to be answered on a regular basis. If it were me, I would be conducting reviews every month to allow me to react and make amendments to future budgets for tighter control. At a bare minimum, you should look at it quarterly.

The need for tighter stock control comes as we delegate the task of ordering stock to key people in our businesses, such as retail managers, stock controllers and dispensary managers. As these people are predominantly employees they generally aren’t aware of the pressures pharmacy owners are under at the moment and generally spend what they feel is necessary.

By way of a recent example, last month one of our team members was ordering stock

Needless to say, the order was cancelled— much to the discontent of the team member— and drastically reduced so that it was in line with the business parameters.

$10,000, which includes enough stock to cover 3 months’ worth of sales, the dispensary manager has to be confident that they can support the dispensary needs for the rest of the month on the balance of $70,000.

If the team member responsible for ordering spends over the set budget by $5000 and is held accountable, they need to be aware that their budget for the following month will be reduced by this amount, or, at a minimum, they need to provide the pharmacy owner with a plan to recoup this amount over an acceptable period of time.

This whole situation would have been avoided if there had been a stock budget in place as the team member would then have known what was achievable.

Controlling expenses on stock is a very effective way of creating savings in your business that may ultimately save you from cutting other, more valuable expenses, such as wages!

Another reason that we need to be more mindful of what is being spent on stock centres on the supply channel. Like everyone else, suppliers are in a tough situation. Every one of them is reliant on volume and this is why we are seeing more and more parcel buys, with minimum stock quantities, being offered by suppliers.

In the climate we operate in now, and if you’re involved in a brand or banner group, you really have to ask yourself whether or not you are getting value for money. If you’re not getting assistance in the areas of budgeting, sales generation and highly personalised service tailored to YOUR business, then you may be in the wrong group for you.

The important thing we need to be aware of (and this includes anyone ordering stock) is that while the discounts associated with these deals may be very attractive, the business may not need this amount of stock.

Why tie valuable cash reserves up in stock for months? It impacts cashflow and therefore places further stress on the business.

At Pharmacy Essentials we provide personalised support not only in budgeting and sales generation, but in many other elements of your business.

If stock budgets are in place, and the team members responsible for ordering are held to account, they need to understand the impact of purchasing parcel buys. For example, if a dispensary manager has a monthly budget of $80,000 and takes advantage of a parcel buy a supplier is offering at a cost of

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

If you would like to know more and are interested in getting real value for money from your fees, contact us at http:// www.pharmacyessentials.com.au/ pharmacists/free-information-pack/ or call me directly on 0412 219 916.

creating Pharmacy Environments Bundilla Guardian Pharmacy Expanding your Pharmacy should be a rewarding experience, for owners, staff and customers.

Initial project brieng should be reassuring and establish trust. All interactions throughout the project must support and develop our Client’s trust in us. That’s why during the entire physical ‘trade through’ tout on site, our team is there for our Client.

This long term Client approached us with a need to expand their Pharmacy to meet the future needs of the existing customers and realise potential new customers.

This Pharmacy, trading from its expanded footprint, provides increased services and product range for their customers in a more comfortable environment. The Pharmacy now utilises the extra space to cater for current growth and will easily modify to allow for increased capacity in years to come. We are extremely proud to have been a part of another successful project for this Client.

Peter Kolb Amcal Pharmacy, Middle Park We’ve retted this particular Pharmacy a number of times over its lifecycle. This is the rst time we’ve undertaken the ret for the current Owner. The development of the shopping centre presented an opportunity for expansion by taking over space from the neighbouring tenant.

A complete shopt was programmed and initiated. We were a little more than ¾ nished the joinery for the project when the development of the shopping centre came to a halt and remained in limbo for over 2 years through the peak of the nancial crisis. Eventually the project restarted with the Owner having joined Amcal. Amcal was introduced to the store plans and the project modied where it could be to suit the rebranding.

Three years after signing on for the project it was nished having gone through two rets before completing the rst one. A record we hope won’t be repeated...

Our Client is happy to have his new Pharmacy and is currently trading on expectations with plans for growth in the near future..

Guardian Pharmacy Cotton Tree The new Owner of this Pharmacy was referred to us as we already had primary project information in place and could quickly progress the make-over of the pharmacy. We upgraded the Dispensary and Service Counters, modied the nish of bulkheads and changed over the oor coverings to comply with new corporate image.

Andrew Tanos Pharmacy, West End

Our team worked around the clock and helped the Owner realise the completion of the project while they remained trading. This Pharmacy looks great in its new livery, has a new lease on life and is ready to take on the next phase of growth led by its new Owner.

The heritage of this West End Pharmacy had to be maintained as we introduced a more modern and functional Dispensary and Retail presence around a brand new Compounding Lab. Challenges created solutions out of the box for our Client and brought about change for the staff and owners. The completed Pharmacy looks fantastic and is ready for the new evolution as a Community Pharmacy.

F

From humble beginnings in 1980, Thomas Brown Shoptters have evolved as specialists in creating

shoptting solutions for Pharmacies throughout Qld and Northern NSW. We currently have ofcial accreditation to provide corporate image touts for Amcal & Guardian Pharmacies. From complete

new store designs to full or partial rets, store extensions or accessory needs, we will work with you and/or

your architects to maximise your store’s efciency and visual appeal. Thomas Brown Shoptters strive to create professional, attractive layouts that allow easy access and create an environment where customers feel at ease. Our expertise extends to merchandise display areas, oor trafc efciencies, signage and any specic personal requirements. Whatever your shoptting needs, we guarantee an impressive design and the highest standard of quality and workmanship, all backed by our professional service and six month warranty.

For enquiries, please phone

(07) 3356 8266

40 Webster Road, Stafford QLD 4053 Fax: (07) 3356 8108 info@thomasbrownshoptters.com.au www.thomasbrownshoptters.com.au

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WHAT’s NEW & company news

Gold Cross launches its NEW pharmacy exclusive range of medicines Gold Cross is proud to announce the launch of its pharmacy exclusive range of medicines spanning through the Cough, Cold & Flu, Analgesic, Allergy and Digestive Health categories.

With all of today’s pharmacy business pressures, Gold Cross is here to help safe guard your future. A proportion of Gold Cross product sales fund the Guild in its important role of protecting pharmacy in Australia.

Cenovis Expands Family Range Cenovis has expanded its popular family friendly range with great new products designed to help keep the whole family healthy, these products complement the existing Cenovis range and continue the brand’s tradition of great quality ingredients in innovative formats.

Products new to the Cenovis kids range: Australian first - Cenovis Vita Sprinkles Flavour Free Multivitamin (RRP $12.95) Vita Sprinkles are a brand new, high quality formulation in an Australian first kids friendly format - a multivitamin that is completely undetectable when mixed into or sprinkled on any food. Mix it into a bowl of spaghetti bolognaise, soup, yoghurt or even just into a toast spread for a little extra dietary peace of mind.

Cenovis Vita Sprinkles Chocolate Multivitamin (RRP $12.95) A chocolate-flavoured version of Vita Sprinkles, this format can be mixed into foods like yoghurt, milk and smoothies, or sprinkled on foods such as cereal or pancakes.

Cenovis Vita Buddies Healthy Bones (RRP $9.95) Great tasting, vanilla flavoured squares containing no artificial colours, flavours, sweeteners or preservatives, with Vitamin D and Calcium.

Cenovis Vita Buddies Multivitamin (RRP $9.95) Great tasting chocolate flavoured squares containing no artificial colours, flavours, sweeteners or preservatives. This multivitamin is a good source of essential vitamins and minerals including Vitamins A, B1, B2, B12, C and D. They are an easy way to top up children’s nutrition when they may be going through periods of fussy eating.

Products new to the Cenovis adults range: New Cenovis Mini Bursts are small capsules that burst in your mouth to release a delicious flavour. You can take up to four a day, so they are perfect for having on the desk at work or in your hand bag when you are out and about. There are three products in the range:

•• Cenovis Mini Bursts Energy (RRP $14.95 •• Cenovis Mini Bursts Immunity (RRP $14.95) •• Cenovis Mini Bursts Multivitamin (RRP $14.95 In addition, Cenovis will introduce for the first time a cold sore relief product, Cenovis Cold Sore Complex (RRP $12.95), which is a Lysine, Zinc and Vitamin C formula that may help reduce the occurrence and severity of cold sores. >> www.cenovis.com.au

With a line-up of powerful pharmacy strength formulations with attractive margins, you can be confident that this new range is primed to deliver efficacy for your patients and profitability for your pharmacy.

The range is proudly endorsed by The Pharmacy Guild of Australia and you can rest assured knowing that this range is pharmacy only forever.

This year Gold Cross has proudly partnered with iNova Pharmaceuticals (a Valeant Company) to distribute the entire range Gold Cross medicinal products. >> www.inovapharma.com

“With all of today’s pharmacy business pressures, Gold Cross is here to help safe guard your future. A proportion of Gold Cross product sales fund the Guild in its important role of protecting pharmacy in Australia.”

Salin Plus Salin Plus is a non-invasive salt therapy device that reduces the frequency and severity of respiratory health symptoms with the simplicity of salt. By replicating the “micro climate” found in salt caves at home, and removing air borne pollutants and enriching the air with salt ions, Salin Plus is bringing the therapeutic benefits of salt-ionised air into the noses and lungs of all Australians.

Salin Plus acts like a cleaner for the entire respiratory system, from the middle ear to deep down into the lungs, emitting tiny salt particles into the air that travel through the respiratory system when inhaled.

From sleep deprivation due to snoring and blocked sinuses, constant coughs, congestion, plus hay fever and headaches, Salin Plus is natural way to gain relief from a wide range of respiratory health issues all year round. It can be used in conjunction with inhalers and medicines such as antihistamines and cold and flu preparations. While it doesn’t provide a cure for any respiratory condition, people may notice an improvement in their quality of life.

Salin Plus is suitable for all ages including children and the elderly; its easy to use thanks to its non-invasive nature, requires minimal maintenance and has quiet operating levels. >> www.salinplus.com

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

WHAT’s NEW & company news

Analgesics – Hard and Fast Rules Recently at the Royal North Shore Hospital in Sydney, RB (Reckitt Benckiser) hosted an exclusive educational evening for community pharmacists. Presenting on the night was Professor Andrew Moore, international expert in pain and evidence. Professor Moore delivered a live presentation which challenged a few commonly-held beliefs and offered pharmacists some surprising insights into optimal pain relief for customers.

In attendance at the event were 35 local pharmacists and additional Pharmacy students. The event was also streamed live via RB HealthHub for pharmacists based interstate or unable to attend in person.

Professor Moore addressed a range of topics relating to acute pain including new thoughts on tension headaches, acute drug treatment and perhaps the topic that was of most interest to the pharmacists was the debate about effectiveness of NSAIDs being taken with and without food.

“A common misconception with analgesics is that they must be taken with food, however there is growing evidence that analgesics for acute pain should not be taken with food as it reduces efficacy and may compromise safety,” commented Professor Moore after the event.

Further discussion topics on the night included the impact of drug formulation on the speed of analgesic relief, the relevance of fed and fasting states on analgesic efficacy and tolerability, the role of muscle tension in particular headache types and how this can influence analgesic choices.

Professor Moore is also in Australia as key note speaker at the Australian Pain Society conference in Hobart this weekend. He will be presenting further research developed through his 30 years’ experience in biomedical research and as Doctor of Science at the University of Oxford.

A New Family Member for PROSPAN This Season!

Are you or a family member suffering from a cough, cold or flu already this season? Don’t be surprised, you’re not alone! Experts say flu season has hit Australia earlier and harder than usual. According to The Australian Medical Association1, more than 2,500 Australians have already been hit with the flu, which is a five-fold increase on last year.

The good news is that PROSPAN COUGH RELIEF has extended their family to include new KIDS PROSPAN so that you can look after your family through the coming months. KIDS PROSPAN is a proven chesty cough expectorant suitable for children aged 0-12 years of age2. It is alcohol-free, sugar-free, non-drowsy, has no colourings but best of all, it tastes great so your kids will actually enjoy taking their medicine!

KIDS PROSPAN is available in 100ml for RRP $14.95. PROSPAN is also available as PROSPAN EXPECTORANT, PROSPAN LOZENGES and INFANT PROSPAN DROPS. >> www.prospan.com.au 1: Australian Medical Association: https://ama.com.au/ausmed/flu-season-may-bestarting-early-year 2: Kraft, K. 2004. ‘Tolerability of dried ivy leaf extract in (52,470) children’. Zeitschrift für Phytotherapie (25):179-181.*

“The PainSmart Challenge results are in – over the last 12 months, the three pharmacies involved in the program have achieved an average gross profit increase in the S3 category of 22 per cent.”

>> www.rbhealthhub.com.au/moore

RB Pain Smart Challenge

For Dry Tickly Cough Choose Isla!

The PainSmart Challenge results are in – over the last 12 months, the three pharmacies involved in the program have achieved an average gross profit increase in the S3 category of 22 per cent.

Isla Dry Cough is a proven DRY cough treatment from the makers of PROSPAN Cough Relief.

The results from S3 Challengers Lillian and Jonathan Chen (Pharmacist Advice, Hammondville, Sydney), Sarah McInerney (General Manager, Dispensary & Professional Services, RX Management), Nathan Lim (Priceline Pharmacy, World Square, Sydney) and Anita Kircher (Soul Pattinson Chemist, Crows Nest, Sydney) demonstrates that by supporting S3 brands such as Nurofen Plus, pharmacy owners can grow business profitability and customer loyalty.

PainSmart mentor and community pharmacist Nick Logan, who announced the results at APP during his plenary session titled ‘Sustainability for Pharmacy? Yes we can!’ said he was thrilled with the outcomes of the program.

Building on the success of the PainSmart Challenge, RB will be launching a new national program to assist pharmacy owners embrace the S3 category. >> www.rbhealthhub.com.au

It has a soothing, balm-like action which coats the mucous membranes in the mouth and pharynx. The outcomes for the patient are:

•• a dry, persistent cough is relieved, •• tickly throat is soothed and relieved, •• vocal cords are soothed and protected from further irritants.

Isla Dry Cough contains the herbal ingredient, Cetraria Islandica, which works as a demulcent. This means that when you suck an Isla Dry Cough lozenge, it produces a protective coating or film over the irritated mucous membranes that line your throat and respiratory tract, soothing and protecting them from further attack.

Cetraria Islandica has been tested in adults and children (from the age of 4 and up)*. Isla Dry Cough is a leading dry cough treatment in Europe and has been marketed in Germany for over 150 years.

Isla Dry Cough (RRP $9.95) is available in a delicious blackcurrant flavour and does have a synthetic or chemical taste. It is also gluten-free and sugar-free. >> www.islacough.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

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52

GuildSmart – Your Smart Pharmacy business tool

WHAT’s NEW & company news

GuildSmart is an exciting new pharmacy business tool from GuildLink designed to assist pharmacies:

When less is more We all know the saying about “less is more”. In the world of the retail pharmacy there is a common dilemma of constantly having to find storage space in the dispensary area.

A new pharmacy in the beautiful country town of Kilmore has a found a unique solution to this age old problem.

The Kilmore Amcal Pharmacy owned by Matthew Liubinas chose two innovative products from Flowsell that drastically increased their dispensary storage capacity within a small footprint.

Matthew has installed his new Rear Feed Dispensary System to hold 450 fast moving medications.

Matthew has used the new Flowsell Underbench Dual Draw System of 12 draws to store all his creams, eye & ear drops and ointments and injections under the dispensary bench. This has provided the new Kilmore Pharmacy with an abundance of storage space which will cater for their future growth.

•• •• •• •• ••

increase sales maximise profit improve staff engagement visualise real-time retail opportunities monitor GuildCare performance

It’s perfect for pharmacy owners and pharmacy retail managers who want to improve the financial efficiency of their pharmacy. The software works with pharmacies’ point of sale and GuildCare software to analyse available opportunities such as OTC generic conversion, companion products and GuildCare professional services unique to the pharmacy.

Prompts at point of sale for OTC Generic conversions and Companion Products allow staff to make the most of each sale while providing patient a holistic health solution.

Matthew states that the new Flowsell System has exceeded their expectations and they plan to utilise these products in their other pharmacies.

GuildSmart allows managers to set profit generating goals for their pharmacy, track progress in real-time and maximise pharmacy’s profitability by utilising opportunities as they happen. The ability to see what sales opportunities pharmacy staff have completed and which have been missed will provide managers with key insights into staff engagement and allocate appropriate key performance indicators.

>> www.flowsell.com.au

>> www.guildsmart.com.au

MiLease Delivers Strategic Lease Management Program to Retailers Phillip Chapman, Director of Lease1, said MiLease has been specifically designed to deliver the resources and advice retailers need to operate profitable businesses.

“The MiLease point of difference is that it is not just a software-driven solution, which the client then has to operate and provide the resources to use the software to manage their lease. The difficulty for retailers of all sizes is how to source the specialised personnel to perform these roles in an efficient and cost-effective manner,” he said.

“A retailer’s lease is the foundation stone for their business success. In the current retail environment, it is apparent that many of the difficulties and stresses being experienced by retailers can be avoided through a program of proactive lease management,” he said.

“This is where MiLease empowers the retailer to achieve the best possible lease performance and outcomes through a program that actually manages the lease and reports along with providing strategic and industry specific recommendations.”

“Through our unique focus on tenant-only representation, we identified a real market need for Retailers/Lessees to have easy access to strategic lease management and advice.

MiLease is a new stand-alone product that strengthens the commitment of Lease1 in delivering personal, timely and costeffective services to save retail tenants time, money and stress.

MiLease has been formally launched to the retail sector to specifically meet the challenges confronted by Retailers/Lessees in costeffectively managing their lease performance.

The MiLease program encompasses:

•• An initial strategic operational lease review

“MiLease has been specifically designed to deliver the resources and advice retailers need to operate profitable businesses.”

with industry specific recommendations and strategies •• Quarterly benchmark and industry KPI reviews and report analysis specific to a client’s retail channel •• Set-up and maintaining an electronic lease diary and events calendar with timely action reminders •• Providing continuing over the phone lease and day-to-day operational advice via toll free phone line

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

•• Strategic portfolio and brand management advice for multi-sited clients.

As a MiLease subscriber each Retailer will also receive:

•• Complete audit and review of their lease and provide report.

•• Set up and maintenance of the critical •• •• •• •• ••

path of their lease in an electronic diary and reminders.

Quarterly benchmark and lease performance analysis and report.

Quarterly Consumer Price Index advice and review relating to the health channel.

Quarterly training video extract from the series Retail Shop Leasing.

Monthly Industry Newsletter on related topics including new developments, leasing outcomes, tips and advice. $1,000 discount where a MiLease subscriber engages Lease1 to assist with their leasing event.

All for less than the price of a cup of coffee ($2.50) per day. Ph: 1300 766 369 Special Offer until the end of July – Pharmacy Guild Members receive the first 3 months free.

Optifresh.

PBS liste d 1st April 2014

SOOthing relief frOm dry eyeS.

Hydrates. Lubricates. Protects.

Optifresh is specially formulated to moisturise, comfort and protect dry eyes. Optifresh is now available in preservative free sterile single dose vials - Optifresh Tears (carmellose sodium 0.5%) and Optifresh Plus (carmellose sodium 1%).

For effective dry eye protection recommend Optifresh!

Preservative Preservative Free Free

Single unit dose vials

Compatible with contact lenses

Fast acting long lasting formula

Pharmacy only

Contact your Strategic National Pharmacy Representative for more information & special deals

BBPP 26261

NSW & ACT 02 9899 9800 VIC 03 5972 0222 QLD 07 3291 7070 SA & NT 08 8352 9200 WA 08 6140 1200 TAS 03 6244 3640

www.optifresh.com.au Petrus Pharmaceuticals Pty Ltd Level 3, 1060 Hay Street, West Perth WA 6005. Tel 08 9368 5954 Fax 08 9368 6692 www.petrus.com.au. Use only as directed.

54

PRODUCT SPOTLIGHT

COCO-SCALP A steroid-free scalp treatment that really shifts the scale. COCO-SCALP is a unique ointment formulation developed by dermatologists as a steroid-free treatment for irritating, itchy scalp conditions such as seborrhoiec dermatitis, eczema, psoriasis and severe dandruff. COCO-SCALP effectively treats these conditions at the roots, and is clinically proven to be more effective at removing scale than coal tar shampoo1.

Reference: 1. Monk B E et al., J Derm Treatment 1995; 6: 159-161.

Gold Cross Cold & Flu Relief Day & Night Gold Cross is proud to announce the launch of its pharmacy exclusive Gold Cross Cold & Flu Relief Day & Night tablets. With a powerful pharmacy strength formulation, this product is for the temporary relief of pains, fever and nasal congestion.

For more information call your iNova Representative or Customer Service on 1300 363 212.

FAB IRON Liquid Iron FAB IRON is a gentle, easy to absorb, organic liquid iron with energy boosting B group vitamins to help restore energy and overall health.

FAB IRON Liquid Iron 250mL bottle RRP $18.95 FAB IRON Liquid Iron 20 x 10mL sachets RRP $18.95 >> www.fabiron.com.au

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

>> www.aftpharm.com

HARTMANN MoliCare Mobile XL

ELEVIT MORNING SICKNESS RELIEF

Now available in Super & Light absorbency

Morning sickness is commonly suffered by pregnant women, particularly during the first trimester. Elevit Morning Sickness Relief is specially formulated with natural ginger and Vitamin B6 to help provide up to 12 hours sustained relief from the symptoms of morning sickness, such as nausea and vomiting. Elevit Morning Sickness Relief does not replace taking Elevit with Iodine Pregnancy Supplement.

Customers can be advised to take both products in conjunction.

MoliCare Mobile is pH balanced and dermatologically tested making it the ultimate skin friendly continence product.

Key features of MoliCare Mobile include:

•• •• •• ••

Look and feel like normal underwear Highest level of leakage protection and keeps skin dry Tear open side-seams for easy changing Maintain the skin’s natural protection layer at a healthy pH 5.5 •• MoliCare Mobile Light is suitable for mobile people with moderate incontinence •• MoliCare Mobile Super is suitable for mobile people with severe incontinence

Elevit Morning Sickness Relief 30pk RRP - $17.95 Contains: Ginger (zinger offcinale) rhizome powder 600mg, Vitamin B6 (pyridoxine hydrochloride) 37.5mg. >> www.elevit.com.au

>> www.hartmann.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

PRODUCT SPOTLIGHT

Little Coughs® for the whole family

Feel Clear with FESS Sinu-Cleanse®

The Ivy Leaf extract in Little Coughs® is an expectorant which helps thin and loosen mucus, eases throat and chest inflammation, while also reducing and calming coughing. Little Coughs® is preservative free, and does not contain sugar, artificial colours and flavours. Unlike many cough syrups for children, Little Coughs is suitable for children under the age of 6 years and can be given to children under the age of 2 years, after consultation with a healthcare professional.

Fess Sinu-Cleanse Hypertonic Deep Cleansing Saline Spray is indicated for the prevention and relief of moderate to severe nasal and sinus congestion. The deep cleansing, non-medicated, continuous saline spray helps to irrigate the nasal and sinus cavities of excess mucus, allergens and other pollutants.

Little Coughs® 100mL: RRP: $13.95 Little Coughs® 200mL: RRP: $18.95 Stockist Inquiries: 1800 788 870. >> www.littlecoughs.com.au

The cleansing mist of the spray also helps to clear and soothe the nasal passages, relieving nasal and sinus congestion due to colds, sinusitis, rhinitis and allergies. It is a mild hypertonic solution that is ‘saltier’ than regular saline to gently draw liquid out of the sinuses and help relieve blocked noses.

RRP: Fess Sinu-Cleanse Hypertonic Deep Cleansing Saline Spray, 100 mL, $16.95.

Stockist Inquiries: 1800 788 870. >> www.fess.com.au

Thomas Brown Shopfitters

Optifresh For soothing relief from dry eye Optifresh is specially formulated to moisturise, comfort and protect dry eyes.

Optifresh Tears (RRP $ 10.55), Optifresh Plus (RRP $ 10.55) and Optifresh Eye Gel (RRP $ 4.12) provide long lasting, soothing relief and protection against the burning, irritation and discomfort due to dry eye. All Optifresh products are now PBS listed. So for effective dry eye protection recommend Optifresh!

Available from Symbion, Sigma & API. >> www.optifresh.com.au

Ideal for Pharmacy and Hospital Satelite Dispensaries the Thomas Brown TrayShelf dispensary shelving system offers Improved dispensary productivity through better work flows and dispensing efficiencies and you save because the TrayShelf dispensary requires less maintenance and labour costs are lower. >> www.thomasbrownshopfitters.com.au

Ezy-Ups Ezy-Ups is designed for people of all ages with flexibility issues due to age, injury, pregnancy and arthritis.

This simple and inexpensive tool allows users to undress and dress themselves without assistance.

This frees them from dependence on a carer which increases their privacy and dignity.

Inner Health Immune Booster for Adults CLINICALLY SHOWN TO HELP REDUCE THE FREQUENCY AND DURATION OF COLDS Inner Health Immune Booster for Adults is a probiotic that may help boost immune system function in adults and help reduce the frequency, severity and duration of colds. Study in Swedish population. Sponsored by Probi AB. Always read the label. Use only as directed. If symptoms persist consult your healthcare professional.

CHC53135-01/14

IHP2831

>> www.ethicalnutrients.com.au

Ezy-Ups rrp $39.95 >> www.ezyups.com GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

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56

RETAIL FOCUS

“For a pharmacy to be sale ready, there needs to be considerable thought leading up to any marketing campaign.”

Is Your Pharmacy Sale Ready?

BY Peter Marshall Principal of Pharmacy Solutions Australia

There are a number of key areas that require early consideration when the possibility of selling your business is raised. To maximise the sales value of your pharmacy it is obviously important to have the strongest possible net profit. It is also highly important that the tenure is secure, and that the lease is fully transferable to a purchaser.

Creating the healthiest possible bottom line is something that cannot be done overnight.

It may be that the gross profit of the store requires improving via better buying and/ or higher generic conversion; this may take several months to implement and what is important is that the impact of these improvements can be readily seen in reports provided to an interested purchaser.

Therefore, it is usual that at least several months’ reporting would be required to give anyone comfort that the changes have been effective.

The control of key expenses is also essential when preparing the pharmacy to go to market. The largest cost centre is the wages and, as such, improvements in this can see large swings in the value of the business.

What are the appropriate wage ratios for your pharmacy? Whether using wage/turnover or wage/gross profit percentages, it is important that the pharmacy is gauged on similar pharmacies and not simply on the averages across all pharmacies.

Changes to staffing levels will require several months of data to justify the tightening of staff numbers. Can the turnover be sustained with less staff? This is the main query that a purchaser will have in relation to

the reduction. Staff levels need to be reviewed constantly (not only when selling) and the modern pharmacist should be acutely aware of the comparative ratios for their business.

The tenure of the pharmacy needs to be closely considered well in advance of putting the business on the market.

One recent pharmacy that we sold required twelve months’ negotiation with the landlord to create a suitable lease for transferring.

There are many issues that may require adjustment so it is important that any changes to a lease be made well prior to the pharmacy being sold. Some of these include:

•• Rent adjustments •• Increased terms (option period added) •• Is there any extraneous floor space that could be handed back to landlord (e.g. underused storeroom)?

•• Changes to numbers of pharmacies (if in a shopping centre) •• Is the bank guarantee the same for a new owner?

•• Are there any owner-specific clauses in the lease that cannot be transferred?

Consideration should also be given to the quality of the information that can be supplied for Due Diligence. By this I mean that

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

a purchaser will want to see audited figures that are preferably quite recent. Information up until the previous month will be required so the accuracy of the pharmacies POS will be called upon for the period of time post the most recent audited accounts.

Another potential issue when selling is the remaining time on any brand contract.

Assessing the “get out costs” and whether they can be overcome by some means, needs to be part of the sale price consideration.

In summary, for a pharmacy to be sale ready, there needs to be considerable thought leading up to any marketing campaign. This consideration should start about 12 months in advance and be as thorough as possible so as to maximise the value of your asset.

Obviously this amount of consideration is not always possible, so it is vitally important that an experienced person is able to assist to draw out all value of the pharmacy before presenting to interested parties.

58

After Hours

AFTER HOURS June–July 2014

BRISBANE

Royal Queensland Show (Ekka) – Where city meets country

Dates and times 8 August to 17 August 2014

canberra

Celebrating the 137th show this year, Queensland’s largest and most loved annual event is almost here. More than 400,000 people will come together at the 2014 Ekka in Brisbane from August 8 to 17 to see the best of Queensland with more than 10,000 animals, 23,000 competition entries, a smorgasbord of award-winning food and wine and hours of free family entertainment. During the 10 days of Ekka, thousands of animals are housed just 1.6 kilometres from the CBD-making this event truly unique in the Australian landscape and epitomising city meets country. Animals have always been, and remain, a main attraction at the Ekka with the now famous Animal Nursery stemming back to 1964.

Fireside Festival Venues around the Canberra region turn up the heat in August for the capital’s annual celebration of winter - Fireside Festival.

Sip on exquisite cool climate wines, taste the delicacies from the region, meet local artists with a passion for their craft, or just relax and warm yourself on open fires in the company of good friends.

Dates and times 1 August to 31 August 2014

Melbourne

Attend a 100 mile dinner. Enjoy a couples relaxation escape. Try dinners of the duck, truffle or degustation variety. Attend a wine master class and lots more.

Hosted by over 20 venues in and around Canberra, check their website for details.

Docklands Fireworks 2014 Fabulous Friday night family fireworks fun, starts July through August.

There’s something about cold, clear, crisp night skies that’s just perfect for fireworks.

The advent of winter in Melbourne means more than just cold weather, winter woolies and comfort food. For those who can’t get enough of fireworks - the crackle and bangs, the smell of smoke in the air, and colourful, awe-inspiring explosions - then winter in Melbourne means Docklands Fireworks, now an institution on the winter family entertainment calendar.

Image courtesy City of Melbourne

Dates and times 4 July to 29 August 2014 Friday: 6pm – 8pm. Fireworks at 7pm

This very popular event was last year expanded from its traditional July home to illuminate the winter skies right throughout August as well, and this year will follow the same crowdpleasing formula. Coincidentally, this year’s program will premiere on a day just made for fireworks. The 4th of July (American Independence Day) has always had associations with fireworks and now Melbourne can join in the fun.

Sydney winter magic 2014 Sizzles in summer – sparkles in winter!

Bondi in winter is a magical place. See it sparkle with restaurants, cafes, bars, coastal walks, theatre, art, markets and winter specials and a full calendar of events and activities.

Skates on! In just 7 weeks a 35m x 13m sized rink ice rink is coming to Bondi Pavilion as part of Bondi Winter Magic. Tickets are on sale from 19 May 2014!

Dates and times 1 July to 31 October 2014

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

60 SECONDS WITH

60 SECONDS WITH...

Nathan Jervis Pharmacist Manager Malouf Pharmacies High Street

I decided to become a pharmacist because...

I have a passion for healthcare and helping people.

My best getaway ever was...

In August Last year I went to Townsville and Airlie Beach with my wife and children, it was great to escape Toowoomba’s cold winter.

I have been working as a pharmacist for...

6 years.

How I keep myself updated to the market news...

By reading journals and industry magazines as well as online news and journals.

What I like best about my job is...

Customers, being able to cater for their needs whilst helping to drive the growth of the business.

My favourite hobby is...

Cars, I love restoring and working on classic cars.

My favourite book is...

The power of one.

Over the next 3 years in pharmacy, I predict...

Pharmacy to become more professional service based and retail focused as PBS price cuts start to reduce dispensary profits.

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

Focus on giving the best customer service you can so customers have the best experience by coming into your store.

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HEALTH CALENDAR

HEALTH CALENDAR June–July 2014

Red Aussie Apple Day 18 June Bowel Cancer Awareness Month, June 2014, is an annual initiative of Bowel Cancer Australia to raise public awareness of a disease that claims the lives of 77 Australians every week. Bowel cancer is the second most common type of newly diagnosed cancer in Australia affecting both men and women almost equally and is Australia’s second biggest cancer killer after lung cancer.

A highlight of Bowel Cancer Awareness Month is Red Aussie Apple Day, where Australians are encouraged to support the vital work of Bowel Cancer Australia through the purchase of a $2 apple pin. > www.bowelcanceraustralia.org

World Continence Week

National Diabetes Week 13 – 19 July Diabetes Australia celebrates National Diabetes Week annually to raise awareness about diabetes in Australia. The campaign aims to educate the community about the risk factors for type 2 diabetes and how this disease can be prevented. >> www.diabetesvic.org.au

23 – 29 June World Continence Week is an initiative of the International Continence Society and is coordinated in Australia by the Continence Foundation.

The theme is Pregnancy and pelvic floor health, and the slogan is Managing the mother load. The theme and slogan support this year’s special project, Pelvic floor awareness in pregnancy, childbirth and beyond, which will see the development of educational resources for health professionals and pre and postnatal women, including a smart phone app.

National Pain Week 22-28 July National Pain Week will take place from 22-28 July 2014. > www.chronicpainaustralia.org.au

The Age Run Melbournee 27 July

75% of vision loss is preventable or treatable if detected early enough, yet every 65 minutes an Australian loses part or all of their vision.

This year The Eye Foundation is calling on Australians to get their eyes tested.

The Age Run Melbourne, presented by People’s Choice is more than just a “fun run”. For many participants, it is an opportunity to give back to the community by raising funds for a cause close to their heart. Over five years, we’ve raised $4.7million for more than 400 charities and we’ve set our sights high for 2014 with a $2 million target! Run Melbourne is a great way to promote healthy living and fitness, participate in a major community event, and raise funds for your chosen cause. So, enter the 3km Kids event, 5km run/walk, 10km run or Brooks half-marathon and start training!

> www.eyefoundation.org.au

>> www.runmelbourne.com.au

> www.chronicpainaustralia.org.au

JulEYE national eye health awareness month July 2014

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

IN THE KNOW

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CLASSIFIEDS 1 x Salofalk Granules 1gram 100 sachets EXP: 04/2017 - Cost $220 3 x Clexane 100mg 10 Syringes EXP: 08/2016 – Cost $75 each 8 x Elecare Hypoallergenic Unflavoured EXP: 08/2014 – Cost $30 each 1 x Relenza 5mg 5 rotadisks and 1 diskhaler EXP: 07/2016 – Cost $30 Selected Body Tools Products, good condition - Clearance as discontinued brand in store, 50% OFF list price Selected INNOXA Skin Care and Make-up, Good Condition Clearance as discontinued brand in store, 30% OFF list price Contact: Melissa at Acton Health Pharmacy QLD, Ph: 07 4627 1552

1 x Zoladex 3.6mg Exp: 10/2014 – Cost $99.00 1 x Androderm 5mg/day 30 patches Exp: 02/15 - Cost $ 39.00

FOR SALE Black Framed Glass Display Cabinet (1900mmH x 570mmW x 430mmD) with four glass shelves, illuminated, on castors, in good condition – Cost $100 (delivery not included).

Contact: Gary at Doc’s Mega Save Chemist, Newcastle West NSW, Email: gary@docspharmacy.net or Ph: 02 4926 3300

4 x Orencia 250mg Exp: 10/2015 – Cost $450each (free delivery) Contact: Monique, The Wesley Pharmacy, Brisbane QLD, Ph: (07) 3371 1754 or Email: frontshop@wesleypharmacy.com.au 1 x Anandron 150mg 30 tablets Exp: 10/14 – Cost $150.00 Contact: Olivia at Elizabeth Street Pharmacy, North Hobart Tasmania, Email: ojgillie@bigpond.com Ph: 0407252729

5X Caduet 10/80 Exp: 10/14

1 x Januvia 50mg tabs Exp: 05/15 – Cost $37.00

2X Caduet 10/80 Exp: 02/15

1 x Vesicare 10mg tabs Exp: 05/15 – Cost $28.00

2X Zeldox 60 Exp: 10/14

1 x Aromasin 25mg Exp: 10/15 – Cost $80.00

All 20% off CLP

1 x Onbrez 300mcg Exp: 09/14 – Cost $29.00

Contact: Nick or Clive at Kawungan Chemmart Pharmacy, Ph: 07 41283080, Email: mail@kpharm.net.au

Contact: Chia, The Arnold St Pharmacy, Bendigo VIC, Ph: (03) 54434514 or Email: arnpharm@frednet.com.au

2 x Actonel 5mg 28 Tabs Exp: Oct 2015 – Cost $26.70 ex gst 1 x Alcasta 5mg 100ml INF Exp: Sep 2014 – Cost $325.00 ex gst 1 x Arcoxia 120mg 10Tabs Exp: May 2015 – Cost $13.40 ex gst 3 x Caverject Impulse 10MCG INJ Exp: Feb 2015 – Cost $10.00 ex gst 3 x Caverject Impulse 20MCG INJ Exp: Mar 2016 – Cost $18.00 ex gst

2 x Aged Care Medication Carts (Avalo Treatment 30 Resident Sachet Cart, sold by Axis Healthcare) 1 used (in good as new condition) and 1 brand new. Dimensions: 770(L) x 600(W) x 1010(H) mm. Work surface area 600 x 500mm Cost $3600 incl GST for 2, or make an offer for individual trolley RRP approx $2400 each.

Buyer responsible for freight, or collection from Kenmore, Brisbane.

Contact: Kirsten, Ph: 0439791124 or Email kirsten@mckerrell.com.au

4 x Dilantin Infatabs 50mg Exp: Dec 2014 – Cost $22.00 ex gst 10 x Endoxan 1g Inj Exp: Sep 2014 – Cost $13.00 ex gst

1 x drug safe Width – 48cm Height – 48cm Depth – 20cm

2 x Hytrin 2mg 28 Tab Exp: Jan 2016 – Cost $18.01 ex gst

1 x drug safe Width – 45cm Height – 60.5cm Depth – 20cm

1 x Megace Acetate 160mg 30Tabs Exp: Oct 2014 - Cost $54.00 ex gst

Please make us an offer!! Pick up only.

3 x Navoban 5mg Cap Exp: May 2015 – Cost $30.00 ex gst

2 x Tykerb 250mg 70 tablets Exp: 07/15 Batch number: AW0016 – Cost $1200.00 each

1 x Oxis 12MCG Turbuhaler 60 Dose Exp: Feb 2015 – Cost $18.00 ex gst 1 x Visken 15MG TAB Exp: Sep 2014 – Cost $2.00 ex gst Contact: Melisa at Bonmore Pharmacy Services, Ph: (08) 92718400 or Email: melisa@bonmore.com.au

1x Nexavar 200mg (60 tablets) Exp: 09/14 – Cost $2000 (save $1200) Contact: Lee Grundy, Branxton Pharmacy, Ph: 0249381156 or Email: branxtonpharmacy@gmail.com

1x Metagenics ThermoPhase Detox Vanilla 686g powder Exp: 8/14 – Cost $30 (W/S ex GST $44.20) 2x Metagenics G-Tox Express 280g Exp: 9/14 – Cost $30 (W/S ex GST $40.60) 1x Metagenics CalmX 270g Exp: 7/14 – Cost $15 (W/S ex GST $25.40) 1xMetagenics Ultra Probioplex 150g powder Exp: 6/14 - Cost $20 (W/S ex GST $30.25)

Contact: Marsha, Paula or Gabby, Marsha Watson Pharmacy, Ph: 03 57621033 or Email: milnerwatson.pharmacy@nunet.com.au

5 x Selfcare Fact Card 12 Pocket A4 wall display systems - Cost $50 each – total of $250 Contact - Helen Di Betta, Medical Centre Pharmacy, Ph: 07 33961966 or Email: 31987m@nexon.com.au

17 x 150w Metal Halide ceiling flush-mount shop wall flood lights used – Cost $35 each.

100 x Hitachi 37w 4’ Fluoro tubes NEW - Cost $1.50 each Contact: Chris, Mt Evelyn Pharmacy, Ph: 0418 551 083, Email:c_farquhar@yahoo.com.au

1xMetagenics PhytoPro 60 Tablets Exp: 6/14 - Cost $15 (W/S ex GST $22.40)

Xeloda 500mg x 120 tabs Exp: 07/2014 - Cost 50% off List price (price is 331.13)

Contact: Sam, Caringbah Compounding Pharmacy, Sydney, NSW, Ph: 02 9524 6795, Email: sghostin@gmail.com

Contact: Joanne at Northampton Pharmacy, Ph: 99341007, Email: northamptonpharmacy@westnet.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 36 : JUNE / JULY 2014

CLASSIFIEDS 1 x Bottle of SPRYCEL (dasatinib) 100mg 30 tabs lot 3b74371 Exp: 08/2015 - Cost 10% off massive saving $500.00

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2 x Prograf XL 1mg 60 Exp 01/2016 Contact: Jay TWC Park Ridge QLD, Ph: 07 3297 0039

Contact: Hamza, Pharmacy Depot Hurstville, Ph: 02 9579 4633

Glass mortar and pestle, Ceramic mortar and pestle, Funnel, Stirrer, Pill counter 2 x spatulas, 1 stamped 5ml dispensing measure, 1 stamped 10ml dispensing measure

POS Touch Till HP ap5000 AiO POS terminal with FRED software and warranty POS Back Office HP RP 5700 SFF C2D-2.8(E7400) 4GB 160GB DVDRW XPP/W7 loaded with FRED Backoffice and warranty Datalogic Magellan 1400i Bar scanner with warranty

1 stamped 100ml dispensing measure, 1 250ml measure Price $130 - Pick up from Quay Pharmacy at Circular Quay Train Station Sydney CBD

Cost: $3000 ONO Contact: Rhonda Warne, Email: rhondawarne92@hotmail.com

Contact: Ray on Ph: 0405 116 386

2 x Seroquel Tablets 300mg 60 Exp: 12/14 – Cost $100 each ex gst 1 x Sinemet Tablets 100/25 100 Exp: 08/14 – Cost $20 ex gst 1 x Diprosone OV Cream Exp: 09/14 – Cost $20 ex gst 1 x Neurontin 400mg Cap 100 Exp: 09/14 – Cost $20 ex gst

PLACE YOUR FREE CLASSIFIED ADVERT If you would like to place your free classified ad, forward any items for sale to Candice.

Email: Candice.radford@goldx.com.au

1 x Androforte 5% Cream 50g Exp: 10/14 – Cost $70 ex gst 1 x Grisovin Tablets 125mg 100 Exp 10/14 – Cost $10 ex gst Contact: Susan or Pooja at Seacrest Pharmacy, Ph: 94489299 or Email: admin@seacrestpharmacy.com.au

BROUGHT TO YOU BY:

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

Have your customers recently taken antibiotics?

Do your customers suffer from gas or bloating?

Want to improve general wellbeing?

Want to maintain healthy digestion and immunity?

Always read the label. Use only as directed.

If symptoms persist consult your healthcare professional.

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

IHP2877 - 01/14 /14 1

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

www.innerhealth.com.au

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Business directory

Business Directory AFT PHARMACEUTICALS HEALTH WORLD

Level 1, 296 Burns Bay Road Lane Cove NSW 2066 Tel: 02 9420 0420 Website: www.aftpharm.com

741 Nudgee Road Northgate QLD 4013 Tel: 07 3117 3300 Website: www.healthworld.com.au

BLACKMORES P.O.Box 1725 Warriewood NSW 2102 Tel: 02 9910 5168 Website: www.blackmores.com.au

INOVA PHARMACEUTICALS Level 10, 12 Help Street Chatswood NSW 2067 Tel: 02 8918 6322 Website: www.inovapharma.com

Would you like to advertise in our new Business Directory?

CARE PHARMACEUTICALS Suite 302 Level 3 75 Grafton Street NSW 2022 Tel: 02 9300 1900 Website: www.carepharma.com.au

PETRUS PHARMACEUTICALS P.O. Box 1808 West Perth WA 6872 Tel: 08 9368 5954 Website: www.petrus.com.au

FLOWSELL 1/13 Network Drive VIC 3201 Tel: 03 9708 2276 Website: www.flowsell.com.au

Contact Candice on Ph: 07 30404415 or Email: Candice.radford@goldx.com.au to enquire about our

early bird rates for the remainder of 2014.

Let’s talk breakthrough reflux Visit rbhealthhub.com.au to order your Gaviscon trial samples.

Always read the label. Use only as directed. If symptoms persist see your healthcare professional. ® Gaviscon is a registered trademark of RB Australia. 44 Wharf Road, West Ryde, NSW 2114. RBGA8327/ITK/Strip. April 2014. Ward6.

NaeNw d d ve o r p im

No matter what the ailment, Gold Cross delivers on a full range of cough and cold products. The new Gold Cross Chesty Cough Relief is a non-drowsy formula to break down and help clear chest mucus, while new Dry, Tickly Cough Relief with Pholcodine provides effective temporary relief of irritating coughs.

Both products are sugar, colour and alcohol free, and like all Gold Cross medicine remedies they are an affordable and effective alternative to the big brands with proven results.

Recommend it with confidence, and join the generations of Australians who have made Gold Cross their first choice too.

For more information contact your iNova Representative or iNova Customer Service on: 1300 363 212

Our TV ADVERTISING draws customers to your store.

Our TRAINING

enables you to give them the best advice.

Our COMMITMENT

to you ensures they come back to you!

AS SEEN ON TV

• Relieve the symptoms of colds • Support healthy immune function • Reduce the duration of colds

IMMUNE DEFENCE HITS TVS NATIONALLY THIS COLD AND FLU SEASON Ethical Nutrients Immune Defence is driving customers into your store this cold ld and flu season!

Help customers improve their immune function and relieve the symptoms of colds, by recommending the natural option customers recognise from TV and the brand they trust; Ethical Nutrients. mers can receive Ethical Nutrients Immune Defence is only available from Pharmacies and Health Food stores, where your customers informed advice; and you can be sure they come back to you, not a nearby supermarket.

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

YOUR NATURAL BUSINESS PARTNER ETH6428 - 04/14

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