ITK June/July 2015 - Edition 42 by Gold Cross Products & Services

Our TV ADVERTISING draws customers to your store.

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ISSUE #42 : JUNE / JULY 2015

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

IN THE KNOW AS SEEN ON TV • Relieve symptoms of colds and flu • Reduce the severity and duration of colds and flu • Support healthy immune function

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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 5th consecutive year!

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• Business Profile

• After Hours

• CPD – Incontinence

• Healthy Ageing

• Down to Business

• The Cost of Caring

Our TV ADVERTISING draws customers to your store.

Our TRAINING

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Our COMMITMENT

to you ensures they come back to you!

ISSUE #42 : JUNE / JULY 2015

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

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IN THE KNOW AS SEEN ON TV • Relieve symptoms of colds and flu • Reduce the severity and duration of colds and flu • Support healthy immune function

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CONTENTS

Category Review 22 The Cost of Caring

COMMUNICATION, COMPETENCY, CONVENIENCE AND HONESTY – THE PILLARS OF OUR PROFESSION

20 Medication Overuse Headache in Community Pharmacy 4 Pain

Down to Business 18 Buyer Beware – Very Aware! 23 Learn to Recruit and Keep the Right Staff 28 HIV Antiretroviral Therapy

32 Healthy Ageing

Guildcare Programs 12 Flu Vaccination

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

I recently met with a former Top 50 tennis professional and golf professional, Scott Draper. Scott is a true professional on a number of levels and will be featuring in ITK from our August edition. An interesting discussion unfolded regarding the synergies between top level athletes and business, more specifically pharmacy. So the question was posed, what defines a top performing pharmacy business? It was interesting although not surprising that three were also key in top level sport, individual or team. We look forward to working with Scott in coming issues. It has been our pleasure to work with Comvita in preparation for this edition. The Business Profile for the company is a highly recommended read with their Olive Leaf range leading the publication from the front cover. The CPD training feature on incontinence along with a host of professional editorials and our regular features completes the edition. As June officially signals the start of Winter 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. Not everyone complains about the Cold it seems. The temperatures are beginning to fall quite noticeably, with our National Capital recording temperatures approaching zero. This edition from front cover to back is full of exciting features, reviews and editorial. Thank you to all the advertisers, contributors, partners and supporters of ITK, we are delighted that you continue to support this growing publication. Best Regards, Sean Tunny Editor

BROUGHT TO YOU BY:

Guild News 3

Biggest Reform Across the Entire Health System

Professional Review 16 Location, Location, Location! 24 Comvita 34 Nuromol

Regulars 40 What’s New and Company News 43 Business Directory

44 Product Spotlight 47 60 Seconds with 48 after hours – Welcome to Wholesomeness 51 Health Calendar

Special Feature 6 Helping Patients Manage Urinary Incontinence

Training and Education 36 Introducing Nuromol with Synchro-Tech 37 Natural Medicines with Pharmaceuticals? 38 The Lowdown on Head Lice

PLEASE USE THIS PUBLICATION TO KEEP YOUR PHARMACY IN THE KNOW. EDITOR: Sean Tunny 0457 029 052 sean.tunny@goldx.com.au 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 Jessica O’Connor – Email: jessica.oconnor@goldx.com.au. In The Know is produced for the information of Australian Pharmacists. The presence of the logo of the Pharmacy Guild does not constitute endorsement of a product. The Pharmacy Guild of Australia accepts no responsibility for claims made by advertisers. Opinions and views expressed in articles do not necessarily reflect those of Gold Cross.

NEWS FROM THE GUILD PRESIDENT

Biggest reform across the entire health system over the last decade George Tambassis National President of The Pharmacy Guild of Australia

As we’ve reached the conclusion of the Fifth Community Pharmacy Agreement, I think it is about time somebody stood up and identified some of the significant benefits the Agreement has delivered for patients and taxpayers.

The 5CPA and the price disclosure changes accompanying it, have delivered arguably the biggest reform across the entire health system over the last decade — a reform that is delivering $20 billion in savings to taxpayers over 10 years, including a forecast $13.9 billion during the 6CPA. A reform that is ensuring that the PBS is totally sustainable and affordable into the future with negligible PBS growth forecast by both the Parliamentary Budget Office and the Intergenerational Report over the next decade (a decade ago the Intergenerational Report predicted the PBS would destroy the Federal Budget). A reform that community pharmacies have embraced in the public interest and have actively participated in at the coalface, often to their own financial detriment, with five consecutive years of real falls in dispensary remuneration. Pharmacies are the true reformers of the health system, delivering many billions of dollars of value to taxpayers through price disclosure – in fact, no other sector across the entire economy is contributing greater savings to the Federal Budget than pharmacy. For other parts of the health system who have stonewalled much more timid reforms — which would have far less impact on their bottom lines — to claim that pharmacies are not delivering value, is hypocrisy in the extreme. As an industry, we have been the true reformers. The result is that the PBS

“Pharmacies are the true reformers of the health system, delivering many billions of dollars of value to taxpayers through price disclosure .”

is sustainable, while the MBS and hospital expenditure continue to grow at rates that significantly exceed GDP, putting ever-increasing pressure on the broader health system. The Fifth Agreement contained far reaching reforms, such as funding for electronic prescriptions; funding for controlled drug real-time recording (still to be implemented through no fault of community pharmacy); pharmacy practice incentives which recognise the need for vital patient services, such as Dose Administration Aids and Staged Supply services, to be delivered to a high standard of quality; continued dispensing of a limited number of medicines to encourage medication adherence and take pressure off doctors and time-poor consumers; recording of clinical interventions; and a patient charter of service for pharmacies. The Fifth Agreement also continued rural pharmacy support to improve access to services for patients living in rural and remote locations; support for Aboriginal and

Torres Strait Islander patients to improve access to community pharmacy services; and a research and development program for independent research into issues related to pharmacy and the provision of quality services to patients. And, of course, the service that underpins the 5CPA just as it has underpinned every Agreement since 1990 — the timely and equitable delivery of PBS medicines to locations across the continent, representing what I regard as the best subsidised medicine model in the world. So, when I hear people, who should know better, disparaging community pharmacy and our Agreement it frankly makes my blood boil. Fortunately, real consumers know the value of their local pharmacy, and those real consumers vote with their feet and go to their local pharmacies frequently — where they know they will get care, attention and value for money from pharmacists and pharmacy assistants who always put their patients first.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

Category Review

Pain By Nate Hentschel Pharmacist, B.Pharm.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

Category Review

Acute Pain in Community Pharmacy

To manage pain in community pharmacy, we first need to have an understanding of what is causing the pain, how severe the pain is, and how long it has been. Generally, acute pain — for example, from injuries — is the only type of pain that should be treated over the counter in pharmacy, while chronic pain should first be investigated by a doctor. It is important to get pain management right by recommending effective and appropriate products, so that we can have the best treatment outcomes for our patients.

Location Usually burns, bruises and cuts are easy to distinguish and are examples of acute pain — that is, pain which will resolve as the damage heals1. Acute pain might be confined to a joint or particular muscle as in sprains and strains. Knowing the location of the pain can help you decide whether topical therapy is appropriate, or refine your choices of analgesics, depending on what has caused the pain. It can also help determine if a referral is necessary — sudden acute pain with no obvious cause could indicate a problem which requires urgent medical attention, as would anything that made you suspect broken bones.

Severity Severity of pain can be a combination of physical, physiological and psychological aspects. Research has shown that anxiety and emotional distress can worsen a patient’s perception of pain, so making the patient feel comfortable and welcome in the pharmacy can be a good start2. It will help to assess the severity by asking the patient to rate their level of pain from 1–10. When speaking to the patient you might also ask them to describe the kind of pain — is it dull, throbbing, aching, sharp? This can help you decide whether to refer the patient or start with stronger analgesics.

Duration Pain will usually persist until the stimulus causing the pain is removed or the underlying cause has healed or been treated — acute pain will typically begin to resolve within 48 hours. Those who have not improved within this time frame should be referred. Where there is no obvious factor causing the pain, or where an injury has seemingly healed but pain persists, a treat and refer approach might be appropriate, but the patient will need to have the cause of the pain properly investigated as soon as possible.

“Acute pain will typically begin to resolve within 48 hours. Those who have not improved within this time frame should be referred.”

Treating pain Treatment in the pharmacy will typically depend on patient preference, the above factors of location and severity, and pharmacist recommendation. Typical first-line therapy is paracetamol, though you may also choose to add either topical or oral NSAIDs such as ibuprofen or diclofenac. Topical products can be useful for localised muscle pain but may not be as effective for joint pain. Also consider the likelihood or impact of adverse reactions. For paracetamol, a big problem is confusion for people taking other products with paracetamol, such as cold and flu medicine, and inadvertently overdosing. For NSAIDs, medical conditions such as asthma, hypertension, kidney problems and reflux need to be weighed against the adverse effect profiles of these medicines. In some cases short-term NSAID use may still be considered safe when compared to the benefits. Pharmacist only products can also be initiated for short-term use in acute pain. Combination paracetamol and ibuprofen products are often an effective choice, and carry no risk of abuse like codeine combination products. Schedule 3 codeine products are often requested by patients; however, there is a distinct lack of evidence that they are any more effective than equivalent doses of paracetamol or an NSAID alone. Research has suggested

that a minimum dose of 30 mg of codeine is required for effective pain relief in combination products3. This is less than most Schedule 3 products, so if you are able to start a discussion with your patient, you may be able to offer them products which are safer and just as effective.

Selecting the right product Even with a direct product request, it is still essential to ensure that a product is appropriate and safe for the patient by checking their other medications or medical conditions and allergies. Assessing the cause and severity of the pain can help determine the kind of treatment you might initiate and also whether a referral is necessary. Choose the right product, or range of products, for the individual and you will achieve the best patient outcomes.

References 1 ANZCA & Faculty of Pain Medicine (2007). Updates for Acute Pain Management: Scientific Evidence. 2nd Edition. 2 Van Der Lugt, C. Rollman, A. Naeije, M. Lobbezoo, F. Visscher, C. (2012). Social support in chronic pain: development and preliminary psychometric assessment of a new instrument. Journal of Oral Rehabilitation. 39(4):270-276. 3 Murnion, B. (2010). Combination analgesics in adults. Australian Prescriber. 33:113-115.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

CONTINUING PROFESSIONAL DEVELOPMENT

“Urinary incontinence is defined by the International Continence Society as being the complaint of any involuntary leakage of urine.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

CONTINUING PROFESSIONAL DEVELOPMENT

Helping Patients Manage Urinary Incontinence Tim Roberts Professional Development Manager, Pharmacy Guild of Australia (QLD) B.Pharm (Hons), AACPA, DipBusMgt

It is estimated that nearly 4 million Australians are affected by urinary incontinence to some degree, with an increase in prevalence seen in people aged over 651. However, despite its relative prevalence, a survey conducted in Australian GP waiting rooms revealed only 30% of participants with urinary incontinence had spoken to a healthcare professional about it2. Pharmacists in the community are well placed to discuss bladder concerns and encourage referrals for patients to seek effective treatments.

Learning Objectives After reading this article, the learner should be able to: •• Identify the clinical features of the different types of urinary incontinence •• Recognize factors which may contribute to incontinence •• Recognize the place in therapy of non-pharmacological management strategies for urinary incontinence •• Describe the place in therapy of pharmacological treatments for urinary incontinence

Competency standards addressed (as defined by the National Competency Standards Framework for Pharmacists in Australia): 6.1, 6.2, 7.1

Accreditation number: G2015017 This activity has been accredited for 0.5 hours of Group 1 CPD (or 0.5 CPD credits) suitable for inclusion in an individual pharmacist’s CPD plan which can be converted to 0.5 hours of Group 2 CPD (or 1.0 CPD credits) upon successful completion of relevant assessment activities.

Clinical Features Urinary incontinence is defined by the International Continence Society as being the complaint of any involuntary leakage of urine3. Normal continence requires coordination between the bladder, urethra, pelvic muscles and nerve supply to the bladder. The detrusor muscle (smooth muscle enclosing the body of the bladder) is innervated by parasympathetic nerves and the bladder neck is innervated by sympathetic nerves4. Additionally, continence also requires adequate manual dexterity, mobility and the cognitive ability to recognize and react appropriately to the bladder filling4. Overactive bladder Syndrome (OBS) and detrusor muscle overactivity can be classified into different types of urinary incontinence, according to the presentation of symptoms;

•• Stress incontinence4,5: Involuntary leakage caused by increases in intra-abdominal pressure overcoming sphincter closure mechanisms. This is a common cause of urinary incontinence, particularly in older women. Obesity, chronic cough and chronic straining during bowel motions are risk factors in the development of stress incontinence. •• Urge incontinence4,5: Involuntary leakage arising from uninhibited bladder contractions (detrusor muscle overactivity/impaired detrusor muscle). In men, this can occur secondary to bladder outlet obstruction in Benign Prostatic Hyperplasia (BPH)

•• Mixed incontinence4: Involuntary leakage associated with both urgency and increased exertion, effort, sneezing or coughing. •• Overflow incontinence4,5: Involuntary leakage due to an overfill of the bladder, can result from significantly impaired bladder emptying. Associated symptoms include weak urinary system, dribbling, hesitancy, frequency and nocturia. Commonly associated with diabetes mellitus and in men, often caused by sever bladder outlet obstruction due to BPH •• Functional incontinence4,5: Incontinence which occurs in otherwise continent individuals who have mobility or cognitive issues which prevent timely use of the toilet. Can be associated with medicines which affect cognition or mental alertness.

Contributing factors One of the initial keys in management strategies is to identify any contributing factors to incontinence. Obesity is associated with an elevated risk of urge and stress incontinence, making weight loss a component of management strategies for many patients6. Constipation may also contribute to incontinence by straining pelvic floor muscles, with treatment of constipation often improving incontinence symptoms7. Another factor which can be addressed is the modifying of fluid intake, as both

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

CONTINUING PROFESSIONAL DEVELOPMENT

“The aim of bladder training is to re-establish voluntary bladder control and also increase bladder capacity.”

excessive and inadequate fluid intakes can have impacts on urinary incontinence. An insufficient fluid intake may result in concentrated urine which can irritate the bladder (worsening incontinence), whilst for excessive fluid intake, a decrease of around 25% may improve symptoms of stress and urge incontinence8. Other strategies relating to fluid intake may involve the reducing of caffeine consumption, which can affect urge incontinence8. An important consideration for pharmacists when reviewing potential contributing factors to urinary incontinence is commonly prescribed medications which may either cause or worsen incontinence (see table 1).

Table 1. Medications which may worsen or cause incontinence, adapted from NPS5,9,10

Management Strategies The aim of management strategies for urinary incontinence is to reduce symptoms and improve quality of life.

Non pharmacological management There are a number of physical and behavioural therapy strategies which can be employed to help manage urinary incontinence. Pelvic floor training involves the strengthening of the pelvic floor muscles, and is a first line treatment for stress or mixed incontinence in both men and women11. Bladder training is first line treatment for men and women with urge incontinence, as it is non-invasive and can be implemented easily with minimal cost. The aim of bladder training is to re-establish voluntary bladder control and also increase bladder capacity – techniques may include a regimen of pelvic floor exercises, scheduled voiding with incremental durations between voids and urge suppression techniques11.

Drug

Mechanism

Type of incontinence

*Anticholinergic agents and drugs with significant anticholinergic effects

Reduce bladder contractions, urinary retention

Retention of urine

Cholinesterase inhibitors eg. donepezil, galantamine

Increase bladder contractions

Urge

Calcium Channel blockers eg. verapamil, diltiazem

Reduce bladder contractions, constipation

Retention of urine

Ace Inhibitors

Drug-induced cough

Stress

Diuretics eg. frusemide, hydrochlorothiazide

Increased urine volume

Urge

Benzodiazepines eg. diazepam, oxazepam

Sedation

Functional

Tricyclic antidepressants eg. dothiepin, amitriptyline

Reduce bladder contractions, sedation

Functional

Selective Serotonin Receptor Inhibitors (SSRIs) eg. sertraline

Increase bladder contractions, sedation

Urge, Functional

There are also a number of absorbent pads and products available in the pharmacy which may be used as an adjunct to other treatments, to avoid discomfort and embarrassment.

Opioids eg. oxycodone, morphine

Reduce bladder contractions, constipation, confusion

Retention of urine

Pharmacological management

Selective Alpha Blockers eg. prazosin, tamsulosin

Relax bladder outlet

**Stress incontinence in women

***Hormone Replacement Therapy

Ineffective urethral closure

Urge, Stress

Pyschotropics eg. amisulpride, olanzapine, haloperidol, trifluoperazine

Constipation, confusion, parkinsonism, sedation, impaired mobility

Overflow, stress and functional

“Anticholinergic (or antimuscarinic) medications are the mainstay of treatment in urge incontinence, used in combination with bladder training techniques.”

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For individuals with functional incontinence related to mobility, assessment from a physiotherapist or occupational therapist may be of benefit and simple measures such as improving toilet access by removing clutter, non-slip flooring, hand rails and raising toilet seat height5.

Whilst conservative non-pharmacological treatments are typically first line, for patients with incontinence not responding to these measures pharmacological treatments may be trialled.

Anticholinergic medications Anticholinergic (or antimuscarinic) medications are the mainstay of treatment in urge incontinence, used in combination with bladder training techniques (unless unsuccessful/impossible). The most commonly prescribed anticholinergic agent for urge incontinence in Australia is oxybutynin – a non-selective anticholinergic agent which is available in both immediate release tablets and transdermal patch formulations12. Newer, more uroselective (selective for M3 muscarinic receptors) agents solifenacin and darafenacin are also available (though not covered through the PBS) and have a lower rate of side effects such as dry mouth and constipation compared to non-selective agents13.

CONTINUING PROFESSIONAL DEVELOPMENT

Anticholinergic agents are effective in reducing the number of episodes of incontinence per day (by about 1.5 episodes per day on average) and the number of voiding episodes in a day (by 2.2 on average)14. Treatment with anticholinergic agents should be undertaken with caution, particularly in the elderly as they are more susceptible to anticholinergic side effects such as blurred vision, dry mouth, constipation and confusion13.

Selective alpha-blockers & 5-alpha-reductase inhibitors Alpha blockers such as prazosin, tamsulosin and terazosin are often used in men with BPH, to relax the bladder and prostate smooth muscle15. When the size of the prostate exceeds 30-40cm, 5-alpha-reductase inhibitors such as finasteride and dutasteride are used to reduce prostate volume and improve urinary flow rate16.

Botulinum toxin Randomised controlled trials show that injection of botulinum toxin type A into the bladder walls is effective in drug refractory and neurogenic OBS, by inhibiting acetylcholine release and dampening detrusor contactility17. This reduces the number of episodes of urge incontinence and can also increase functional bladder capacity17.

Help your patients manage urinary incontinence With urinary incontinence being a common chronic medical condition affecting many of our patients, pharmacist are ideally placed to provide support, assistance and referrals to patients who are experiencing bladder troubles. Some key tips for pharmacists to remember;

Consider potential contributing factors to urinary incontinence, particularly fluid intake and caffeine consumption as well as common medications which may also cause or exacerbate urinary in continence

Encourage patients to talk to their general practitioner if they are experiencing episodes of urinary incontinence, also consider other allied health professionals such as physiotherapists and occupational therapists.

Watch out for side effects with pharmacotherapy options, particularly with the use of anticholinergic agents in the elderly.

Donâ&#x20AC;&#x2122;t forget to provide a comfortable and private counselling space when discussing bladder issues and concerns, to help keep your patients at ease and avoid embarrassment!

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CONTINUING PROFESSIONAL DEVELOPMENT

References 1 Australian Institute of Health and Welfare. Australian Incontinence data analysis and development. Canberra. Australian Institute of Health and Welfare 2006 2 National Prescribing Service. Managing urinary incontinence in primary care. NPS News. 2009: 1-5 3 Abrams P, Cardozo L, Fall M et al. The standardisation of terminology of lower urinary tract function. Am J Obstet Gynecol. 2002; 187:116-26

ASSESSMENT QUESTIONS

4 Thirugnanasothy S. Managing urinary incontinence in older people. BMJ. 2010; 341:c3835

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

5 Department of Veterans Affairs (DVA). Veterans Mates: Therapeutic brief 26 – The impact of commonly used medicines on urinary incontinence. Department of Veterans Affairs. 2011

question 1

question 4

Which of the following best describes the clinical features of ‘stress incontinence’?

Which of the following medications would be most appropriate for treatment of urinary incontinence symptoms in an elderly male patient with BPH, whose prostate size exceeds 30cm?

6 Dallosso H, McGrowther C, Matthews R et al. the association of diet and other lifestyle factors with overactive bladder and stress incontinence. BJU Int. 2003; 92:69-77

a. Involuntary leakage caused by overfilling of the bladder b. Involuntary leakage related to detrusor muscles overactivity or impairment

a. Botulinum toxin

c. Involuntary leakage due to increased intra-abdominal pressure

b. Prazosin

d. Involuntary leakage due to mobility issues

d. Tamsulosin

question 2 Which of the following medication classes is most likely to aggravate ‘urge incontinence’ a. Selective alpha-blockers b. Ace Inhibitors c. Benzodiazepines d. Cholinesterase inhibitors

question 3 Which of the following interventions would be considered the most appropriate initial management strategy for a patient with ‘functional incontinence’?

c. Finasteride

question 5 Which of the following statements regarding treatment with solifenacin is correct? a. Solifenacin reduces the number of stress incontinence episodes by 2.2 episodes per day b. Solifenacin more selective for M3 muscarinic receptors than oxybutynin, and has a lower rate of dry mouth and constipation

7 Byles J, Millar C, Sibbritt D et al. Livingwith urinary incontinence; a longitudinal study of older women. Age ageing. 2009 38:333-8 8 Hashim H, Abrams P. How should patients with an overactive bladder manipulate their fluid intake. BJU Int; 2008 62-6 9 NPS – Better choices, Better Health. NPS News 66 (insert) 2009 – medicines that may cause or make urinary incontinence worse. 10 Tsakiris P, Oelke M and Michel M. Drug-induced urinary incontinence. Drugs ageing 2008: 25 (7): 541-49 11 Royal Australian College of General Practitioners. Managing incontinence in general practice; Clinical practice guidelines. Melbourne; RACGP 2002 12 Dmochowski R, Sand P, Zinner N et al. Comparative efficacy and safety of transdermal oxybutynin and oral tolterodine versus placebo in previously treated patients with urge and mixed urinary incontinence. Urology 2003; 62:237-42

c. Solifenacin reduces voiding episodes in patients with urge incontinence by 1.5 episodes per day

13 Hedge S. Muscarinic receptors in the bladder: from basic research to therapeutics. Br J Pharmacology 2006; 147 supp 2: s80-7

d. All of the above

14 Hartmann K, Mcpheeters M, Biller D et al. Treatment of overactive bladder in women. Evid Rep Technol 2009: 1-120

a. Anticholinergic therapy b. Pelvic floor training exercises c. Assessment from a physiotherapist or occupational therapist d. Reduction of caffeine intake

15 Wilt T, N’dow J. Benign Prostatic Hyperplasia management. BMJ 2008; 336:206-10 16 Perry S, Shaw C, Assassa P et al. An epidemiological study to establish the prevalence of urinary symptoms and felt need in the community. J Public Health Med 2000; 22:427-34 17 Duthie JB, Vincent M, Herbison G et al. Botulinum toxin injections for adults with overactive bladder syndrome. Cochrane database Syst Rev 2011;CD005493

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

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GUILDCARE PROGRAMS

Flu Vaccination BY ROMA CECERE General Manager – Strategic Business Performance, GuildCare

“With the exception of safe water, no other modality, not even antibiotics, has had such a major effect on mortality reduction (than vaccination) …” 7

Influenza is a viral illness caused by the Influenza A and B viruses. It is highly infectious, spreading through infected droplets in the air after sneezing or coughing, or by hands which have been in contact with the virus. The worst epidemic in world history was the influenza pandemic of 1918–1919 where more than 20 million people died. Today, the World Health Organisation (WHO) estimates that between three and five million cases of severe illness and between 250,000 and 500,000 deaths occur every year around the world associated with influenza.1

FLU IMPACTS MORE THAN THE PATIENT A study found that, in Australia, influenza caused 18,000 hospitalisations, and over 300,000 GP consultations with patients, costing the Australian health care system at least $85m annually.2 According to the Queensland Department of Health, it is estimated colds and flu cause

Australian businesses to lose 1.5 million workdays each year.3 Between 1 Jan and 10 October 2014, 72 influenza-associated deaths were notified to Australia’s National Notifiable Diseases Surveillance System (NNDSS). The median age of death was 72 years old. People suffering from chronic illnesses and the elderly are at higher risk. They can develop complications, such as bronchitis and pneumonia, which may result in hospitalisation and, on occasion, death. Anyone aged 65 years and older, and Aboriginal and Torres Strait Islander peoples aged 50 years and over, are at high risk from influenza (flu) and pneumococcal disease and the complications of these diseases, with the great majority of deaths from these conditions occurring in these age groups.4 The Australian Government funds free flu vaccine for all Australians aged 65 years and older from General Practitioners and Immunisation Providers. Similarly,

“The World Health Organisation (WHO) estimates that between three and five million cases of severe illness and between 250,000 and 500,000 deaths occur every year around the world associated with influenza.”

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free pneumococcal vaccine is provided to all Australians aged 65 years and older.

FLU VACCINATION ROLLOUT DELAYED IN 2015 This year, the rollout of the Flu Vaccination was delayed by 5 weeks, starting in late April. The main reason for this was that the vaccine contains three seasonal influenza strains, with two strain changes from the 2014 vaccine. This double-strain change caused manufacturing delays. Queensland recorded 1,380 lab-confirmed cases of flu in the first quarter, higher than any other state in Australia. The numbers were almost double the state’s average, compared with 1,044 in New South Wales and 704 in South Australia.5

PHARMACISTS’ ROLE GROWING Pharmacies have been able to provide flu vaccination in some states since 2011. Today, pharmacies nationally are as close as ever to being allowed to provide this key professional service. A pharmacy must have an accredited vaccine administrator on site to offer the vaccination service to patients. In 2014, the Queensland Pharmacist Immunisation Project (QPIP) saw pharmacists at 80 community pharmacies successfully administer more than 10,000 influenza vaccinations. According to QPIP, 14 per cent of those had never been vaccinated before — 96 per cent of people vaccinated were ‘completely satisfied’ with the pharmacist-delivered vaccination service; and 97 per cent would return to a pharmacy for future vaccinations.6

GUILDCARE PROGRAMS

In January, the Western Australia (WA) Health Department and Pharmacy Guild of WA took a significant step in reaching agreement for their Pharmacies to administer influenza vaccination. WA Guidelines state that flu vaccinations may be provided at a Pharmacy registered under the WA Pharmacy Act 2010 and administered by those only after successfully completing accredited training programs.

GUILDCARE HELPS PHARMACY MANAGE VACCINATIONS Unlike other programs, GuildCare helps pharmacies navigate professional service delivery with one seamless software solution. It’s easy to use and records everything, allowing for patient review and their ongoing management. A Vaccination Recording Service is part of GuildCare’s Patient Services module.

It provides a patient consent form, a screening checklist for vaccination suitability and frequently asked questions to support patient interaction. The software program records the vaccine administered and all details of administration, such as batch number and site of administration. It is fully compliant with Quality Care Pharmacy Program (QCPP) and state guidelines.

WHAT SUPPORT IS AVAILABLE? The GuildCare Support Team can assist with any questions you have in becoming a subscriber. Training and technical support are also available. Simply email support@guildcare.com.au or call 1300 647 492 (8.00 am – 6.00 pm weekdays) and visit www.guildcare.com.au

references 1 www.isg.org.au/index.php/about-influenza/impact-of-influenza/ 2 Newall, A et al. Economic report into the cost of influenza to the Australian health system. March 2007 3 www.mtmag.com.au/workers-who-spread-flu-cost-1-5-million-lost-days/ 4 http://www.health.gov.au/internet/immunise/publishing.nsf/Content/older-aust 5 www.couriermail.com.au/news/queensland/delay-in-flu-vaccine-stocks-results-in-increased-number-of-casesof-virus-victims/story-fnn8dlfs-1227296206905 6 www.healthtimes.com.au/hub/public-health/50/news/kk1/pharmacy-trial-moves-into-second-phase/151/ 7 UN Report (1) Plotkin SA, Orenstein WA, Offit P. Vaccines, 5th ed. Saunders, 2008.

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Professional Review

Location, Location, Location! Research your lease and benefit from the power of information BY Phillip A. Chapman Phillip A. Chapman is the Founder of Lease1 and Director of MiLease Strategic Lease Management, both of which are endorsed Gold Cross Member Services.

When we enter into a lease or purchase a business with an existing lease it is an unfortunate trait of human nature that any research on the location and its suitability invariably stops there and then. Retail Leases are complex, with very specific conditions and critical events, and it is safe to say that it is not until one of these events is upon us that we start scrambling to pull together the data required. This is a very reactionary approach and such data will usually be limited to the current location and skewed to support a singular position on rent. However, there are many different locations out there, from suburbs and shopping strips, to retail precincts and shopping centres, and the markets they create and operate in are constantly changing. With expanded price disclosure, there are two key questions that Pharmacists need to constantly ask themselves: Is my shop location still relevant, and is it still suitable for my Pharmacy?

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

Professional Review

“Retail Leases are complex, with very specific conditions and critical events, and it is safe to say that it is not until one of these events is upon us that we start scrambling to pull together the data required.”

Research is mandatory Research into current store location and other location alternatives, as well as your market pitch, branding, your competitors and Lessor, is mandatory. As an example, a recent outcome of applying sound research to an existing Pharmacy with a pending lease renewal showed that the business did not need to remain within its current shopping centre location. Being adjacent to a large Supermarket for over 10 years, as well as the Landlord’s expectation on rent when compared to the real estate performance, identified that these premises were no longer suitable for the Pharmacist. Renewing their lease, even at the passing rent, was not prudent business.

“With all the research data available to you, think of the leverage you can create at your next rent review with your Landlord.”

Prescription numbers increased through greater access and convenience, along with trading hours to meet patients’ needs, and not those of the Supermarket.

Our client was well researched and now trades directly across the road with the comfort that no competing Pharmacy can take up a lease.

The research also incorporated nearby location options and with this data available the Pharmacist was able to make the bold decision to re-locate their store.

While retail sales did reduce slightly at first, sales soon exceeded those at the old shopping centre site due to the support of their franchise in re-aligning the range and merchandising to meet the new site’s customer demands and convenience.

Although seen as an inferior site, the vacant video shop directly across the road with main road corner access, dedicated parking and even a pylon sign, proved to be far more suitable for the future of this business. A highly motivated Landlord also further enhanced the appeal of this option.

The overall cost of the move was more than covered by the significant increase in profits. When dovetailed with a long-term lease with options, the value of this business reached levels that would never have been achieved if it had remained positioned alongside a major Supermarket.

The outcome

We were pleased to learn that the Lessor of our client’s old shopping centre site is still wondering what happened!

at your next rent review with your Landlord.

That’s right! The Landlord did not do their research on the Pharmacy channel, and its challenges, alternative sites, including those right on its doorstep, nor the ACPA Locality Rules.

market pitch, branding and promotions

As a result, the Pharmacist’s occupancy costs were halved and the business also benefited from some further generous rent incentives. The Pharmacy was also free from the constraints of its previous shopping centre location in terms of trading hours, signage, marketing and car parking.

Update: the Landlord of the old shopping centre took a seven-figure hit to their property value and not surprisingly changed their Managing Agents.

Information is Power As this example shows, the value of research, not just at a critical lease event, but as an ongoing focus, can empower your business. With all the research data available to you, think of the leverage you can create More importantly, you will always be better placed to ensure that your Pharmacy, remain relevant and aligned to the commercial terms of your lease. >> www.lease1.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

DOWN TO BUSINESS

Buyer Beware – Very Aware! Peter Saccasan FACP FCA CTA Director of Pharmacy Services, RSM Bird Cameron Chartered Accountants

When it comes to buying any business, the Latin term “caveat emptor” – let the buyer beware – has particular application. It means that the onus is on you, the buyer, to investigate as much as possible what you are buying and to rely only on your own investigations. Whatever the vendor tells you, or the broker who is acting as the vendor’s agent, should not be taken at face value. Potential pharmacy owners should ensure they properly investigate the business they are buying. Essentially, the contract you sign to buy a business will say words to the effect that anything not included in the contract cannot be relied upon.

Price and Profit Generally a pharmacy business will sell for a price based on a multiple of profit or the application of a rate of return to the profit. The multiple will reflect the risk that is perceived to be attached to that business and the ability to continue to earn the stated profit. The profit is — well, supposed to be — what is laid out by the vendor in their last profit and loss statement for the business, which is presented to the purchaser. For example, if profit is $200,000 and the acceptable rate of return is 18%, then the purchase price will be $1,111,111. Profit is normally the business profit before interest on borrowings and after allowing a salary for the owner who has to work in the business. The usual procedure is that the actual profit and loss statement is laid out and then adjustments are made to that record to reflect what might be a normal operating outcome for the business. My observation is that some of the adjustments put forward can be somewhat contentious.

Acceptable adjustments? I have set out below some of the common adjustments I see, or which are NOT made but should be, and some points for consideration around these adjustments.

Adjustment

Comments

Gross profit dollars from sales reduced

The impact of PBS reforms is well known. If you are looking at the profit made in a pharmacy in the year ended 30 June 2014 or even 2015, it is most likely that the gross profit dollars to be generated in 2016 will be lower. Some vendors are realistic and offer some reduction, many don’t and with no explanation as to why there should be none. If you do not reduce the GP dollars, profit remains inflated and so will the price of the business.

Wages expense reduced

The vendor might suggest that the wages are too high and that the new owner can operate with fewer staff. Wages can be obviously too high if employees on the payroll will not be continuing and will not need replacing, such as people related to the vendor. Some vendors apply a blanket reduction, again with no explanation. For those pharmacies who service a large number of nursing home prescriptions, you should ensure that any reduction takes this into account. By reducing wage costs, profit is higher and so is the price of the business.

Banner Group fees added back to profit

The vendor is suggesting that these fees are discretionary. I would disagree. For example, if you are buying an Amcal pharmacy, you will continue to pay the Amcal fees. If you decide to change banners or franchises, then that is entirely a separate decision. If these fees are added back, profit is higher and so is the price of the business.

Repairs reduced

An owner might spend a large amount in one year on some one-off repairs. It is reasonable to assume that such a high amount won’t occur each year. By reducing this expense, profit is higher and so is the price of the business.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

DOWN TO BUSINESS

Finance and other matters When buying a pharmacy, there are many other issues to address, for which we do not have space to consider here. To name just a few – a. Does the pharmacy service Nursing Homes and what share of profit do they contribute? b. What is the right rate of return for this pharmacy? c. How much do you need to borrow and how will this be arranged? d. What business structure will you use and what documentation is needed for this? e. What is your strategy and plan for this pharmacy? f. What systems do you need to have in place when you take over? g. Does the store need a refit? If so, when will you do this and how do you go about this? h. What are the terms of the lease of the premises? i. How do you make application to the Pharmacy authorities? j. What does giving a personal guarantee mean?

Remember, it’s your money One more thing — do not be put off if you believe the right purchase price is well below the asking price of the vendor. Remember, it is you who has to pay back the money you borrow from the bank. If you believe you have properly assessed the business, stick to your guns and do not pay too much for the business. It is no different to going to a property auction and paying way above what you think the property is worth. Don’t worry that you might be offending the vendor with a low offer. That just may be the right price to pay. So — caveat emptor — and you will successfully complete your acquisition in good time.

Category Review

Medication Overuse Headache in Community Pharmacy: A Brief Review BY Phil Spyrou Pharmacist, B. Pharm, International Headache Society

What is Medication Overuse Headache? Medication Overuse Headache (MOH) is defined by the International Headache Society as a headache occurring on more than 15 days of the month which has developed or worsened during medication overuse and resolves or reverts to its previous pattern after the overused medication is withdrawn1. Medications that can cause this condition include triptans, opioids, combination analgesics (used regularly on more than 10 days a month) and even simple analgesics such as paracetamol and NSAIDs (used regularly on more than 15 days a month). The features of MOH vary, depending on the type of medication being taken in excess. Interestingly, patients who frequently use analgesics for other conditions such as arthritis do not suffer from the condition.

How does Medication Overuse Headache affect the community? Chronic headaches are debilitating and the personal and societal costs caused by MOH are immense, yet underestimated. The individual cost per annum to society due to MOH is almost triple the cost of migraines3. Indirect costs due to reduced productivity and absenteeism contributes to 90 per cent of the overall costs.

Patients experiencing MOH have been found to experience a lesser quality of life compared to people who do not experience headaches4. With roughly one in 50 adults suffering from MOH2 it is clear that awareness needs to be raised so the effects of MOH can be minimised.

Diagnosis The International Headache Societyâ&#x20AC;&#x2122;s classification of MOH should be considered when consulting patients who regularly use analgesics to treat headaches. The collection of an accurate history regarding frequency of headaches and medication use, supplemented with the use of a headache diary, is imperative for a diagnosis to be made. It is also important to rule out the possibility of a medication induced headache which can be caused by calcium channel blockers, nitrates, dipyridamole, phosphodiesterase type 5 inhibitors, combined oral contraceptives and hormone replacement therapy.

Treatment Due to the heterogeneity of the condition and a lack of randomised-controlled trials, there is no worldwide consensus on the most appropriate treatment for MOH. However, withdrawal of the overused medication(s) along with education is widely

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

recommended as the treatment of choice2. Treating uncomplicated cases of MOH in pharmacy will prevent placing a burden on GPs and specialists. Importantly, patients who have previously not responded to withdrawal attempts or have psychological co-morbidities should be referred to a doctor. Some patients may require prophylaxis of headaches to avoid overuse of analgesics in the future. There are both prescription5,6 and natural medicines7 available with evidence to prevent Tension-Type Headaches (TTH) and migraine.

What role do pharmacists have? Pharmacists are the most accessible health professionals and the majority of medications that cause MOH can be purchased over the counter. Pharmacists are therefore well placed to provide education and support to patients who have, or are at risk of developing, MOH. Prevention is an area where pro-active pharmacists can play a vital role. They should encourage patients to avoid treating headaches with analgesics on more than two or three days of the week. Current guidelines do not recommend the use of opioids such as codeine for treatment of migraine8 and TTH â&#x20AC;&#x201D; the use of opioids for headaches should be discouraged.

Category Review

MOH is a clinical diagnosis and there are no laboratory tests available. Treatment usually does not require prescription medications. Pharmacists can therefore play an important role in diagnosing and treating the condition. It is imperative that patients are counselled in a friendly, discreet and nonjudgemental manner. MOH sufferers are already frustrated and care should be taken to ensure that they don’t misinterpret the information relayed to them. While some patients may be frequently overusing pain relievers, it doesn’t mean that they are ‘addicts’.

“Medication Overuse Headache (MOH) is defined by the International Headache Society as a headache occurring on more than 15 days of the month which has developed or worsened during medication overuse and resolves or reverts to its previous pattern after the overused medication is withdrawn1.”

Pharmacists should also train their staff to be aware of this condition, how best to manage sales of analgesics and know when referral to the pharmacist is required. With appropriate staff training and systems in place, pharmacists can ensure that all patients who suffer from MOH receive the support and advice they deserve.

If you are interested in how you can build customer loyalty by diagnosing MOH and in increasing sales of preventative medicines for headaches, email Phil Spyrou at phil.spyrou@outlook.com

references 1 Headache Classification Committee of the International Headache Society (IHS 2013, The International Classification of Headache Disorders, Cephalalgia 33 (3) pp. 629–808. 2 Kristoffersen ES & Lundgvist C 2014, Medicationoveruse headache: epidemiology, diagnosis and treatment, Therapeutic Advances in Drug Safety 5(2) pp. 87–89. 3 Linde M, Gustavsson A, Stovner L, Steiner T, Barre J, Katsarava Z et al 2012, The Cost of headache disorders in Europe: The Eurolight Project, European Journal of Neurology 19 pp. 703–711. 4 Lantéri-Minet M, Duru G, Mudge M & Cottrell S 2011, Quality of life impairment, disability and economic burden associated with chronic daily headache, focusing on chronic migraine with or without medication overuse: a systematic review, Cephalalgia 31 pp. 837–850. 5 Therapeutic Guidelines 2015, Tension Headache. 6 Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C & Ashman E 2012, Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults, Neurology 78 pp. 1337–1345. 7 Holland S, Silberstein SD, Freitag F, Dodick DW, Argoff C & Ashman E 2012, Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults, Neurology 78 pp. 1346–1353. 8 Therapeutic Guidelines 2015, Acute Migraine Attack. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

Category Review

The cost of caring

By Maria Whitmore

The Intergenerational Report 2015 prompts us to contemplate the increasing amount of time left before we shuffle off this mortal coil. So too might we contemplate the financial and personal cost to family members and friends who may end up caring for us. There are presently 2.7 million unpaid family and friend carers in Australia1 looking after the most vulnerable in our society, including approximately 140,000 who need help with bladder or bowel control2.

To draw attention to the plight of carers of people with incontinence, the Continence Foundation of Australia will launch a national campaign, Tell someone who cares, during World Continence Week, June 22–28.

We know the care needs of people with incontinence are much higher than those of others needing care. In 2009 there were nearly 73,000 primary carers looking after people with severe incontinence; the majority of these female (81%), most (73%) spending 40 or more hours each week caring, and more having their sleep interrupted (42%) than other primary carers (19%)3.

The campaign, supported by Carers Australia, will include the launch of new resources for carers of people with incontinence, such as a carer guidebook, dedicated web pages and short videos on the Continence Foundation website. The new resources will also outline the available support services, including the National Continence Helpline, which can assist with information and referrals to health and support services.

There’s also a financial cost — the productivity loss to people who work unpaid as carers of people with incontinence is estimated to be $2.7 billion annually4. And there’s an emotional cost — we know these carers are twice as likely to report stress-related illnesses compared to other carers3.

The Continence Foundation’s chief executive Barry Cahill said support and recognition for the extraordinary contribution carers made to society was long overdue.

supported through resources and education, preparing people for the challenges they face and reassuring them help is available,” Mr Cahill said. Carers Australia’s chief executive Ara Cresswell said involvement with the Continence Foundation’s campaign would have ongoing benefits for carers. “Providing unpaid family and friend carers with information and practical advice can be vital to ensuring the sustainability of the caring relationship and to the health and wellbeing of both the carer and the person they care for,” Ms Cresswell said. The National Continence Helpline (1800 33 00 66) is staffed 8 am–8 pm Monday to Friday by continence nurse advisors who provide advice, referrals and resources to consumers, carers and health professionals.

“If we want people to be cared for in their own homes longer, then carers need to be better Further information is also available at www.continence.org.au

“We know the care needs of people with incontinence are much higher than those of others needing care.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

References 1 ABS (2012) Survey of Disability, Ageing and Carers. 2 Access Economics (2010) The Economic Value of Informal Care in 2010. 3 Australian Institute of Health and Welfare (2009), Incontinence in Australia. 4 (Deloitte Access Economics’ 2011 report, The economic impact of incontinence in Australia.)

Guild Pharmacy Academy update!

down to business

Learn to recruit and keep the right staff As competition in community pharmacy becomes fiercer, pharmacies are looking at new ways of attracting customers into their store. Professional services and programs to improve customer loyalty have been hot topics at recent industry conferences and pharmacies of all shapes and sizes are embracing the trend. But having the right people to run the new initiative is as important as choosing which initiative to adopt.

The Pharmacy Guild of Australia has developed Making Smart Recruitment Decisions, a suite of three online courses for pharmacists, aimed at addressing how to find and keep good employees in community pharmacy. The online courses can be completed by pharmacy managers and pharmacists in sequence to improve current knowledge of the topic, or consulted as a technical resource whenever they are preparing to recruit staff.

Recruiting staff is both expensive and inevitable. It is an essential part of any business and, if done properly, the rewards are twofold. The right person for the job will contribute greatly to the success of your business but also be more inclined to stay with the business longer. In these cases, the effort and expense you put in at the recruitment stage will reap rewards well into the future.

The first course, titled Activating the Recruitment Process, is now available on the Guild’s online learning platform, myCPD, and discusses the key actions pharmacy managers should take to activate a recruitment process in their pharmacy.

Pharmacy’s embrace of new professional services is a double-edged sword. On one side you have the enthusiasm and expectation that comes when introducing something that will help break the routine of pharmacy and diversify your daily duties. On the other side you have the resistance to change, whether overt or subconscious, and the cynicism that can arise when the accepted status quo is disrupted. The skills and qualities required to staff new services and customer programs must be considered in any future recruitment. Additionally, job descriptions must reflect the change in work duties to ensure you hire the right person with the right skills for the right job. Making sure the new staff member understands their role in the pharmacy and the expectations of them in that role prior to accepting the position will drastically reduce staff turnover.

Activating the Recruitment Process is accessible via the Guild’s online learning platform, myCPD. The course is free to all Guild members and their employee pharmacists. The course is available to non-members for $250, payable upon enrolment.

To register for or access myCPD, visit www.mycpd.org.au. You can contact the Guild Pharmacy Academy on (03) 9810 9930 or via email at guildpharmacyacademy@guild.org.au

To subscribe to updates from the Academy and access this course, simply enrol your staff in the Guild’s online learning platforms myCPD (for pharmacists) and GUILD INTERN myLEARNING (for pharmacy assistants) via our website www.guild.org.au/academy

This activity has been accredited for 0.5 hours of Group 1 CPD (or 0.5 CPD credits) suitable for inclusion in an individual pharmacist’s CPD plan, which can be converted to 0.5 hours of Group 2 CPD (or 1.0 CPD credits) upon successful completion of relevant assessment activities.

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GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

Professional Review

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

We continue our popular business profile series of leading companies actively working in the Australian Pharmaceutical Industry. It gives me pleasure to profile Comvita, an innovative global company with a long established reputation for premium quality health products, enjoying a strong Australian presence and appeal with consumers.

We recently spoke with Simon Pothecary, General Manager, Australia, to provide a little background, insight and professional predictions for the group and industry in 2015.

Editor – The story of Comvita is steeped in heritage and enjoys a strong position in pharmacy. The company was founded in 1974, can you provide a little background to our readers regarding the journey of Comvita?

years of age — was a strong advocate of Olive Leaf Australia’s Fresh-Picked extract. The same year Comvita also acquired MEDIHONEY®, Australia’s biggest honey-based wound care company. In 2013 Comvita purchased another fresh olive leaf grove in South East Queensland and today we have approximately one million olive trees across our two plantations.

Simon – Like many great natural product companies, Comvita grew from humble beginnings. Beekeeper, Claude Stratford, established the company in 1974 in the Bay of Plenty, New Zealand, with a mission to ‘produce natural products that improve the community’s health’. Claude’s pioneering spirit and passion for the caring of others are the foundation of Comvita.

Editor – Your role at Comvita is an important and diverse position. Can you give us some insight into your role at the company?

In 2007 Claude convinced the Board of Directors to purchase Olive Leaf Australia, Australia’s leading brand of Olive Leaf extract products. Claude — who lived to almost 103

and experienced team who consistently

Simon – My role is to grow Comvita’s sales and profits in Australia, establishing and accomplishing the local company objectives. I’m fortunate to be supported by a professional exceed expectations. Australia has become the most important market for Comvita and we are determined to keep it that way!

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

Editor – While a catchcry of many companies today, Comvita is genuinely anchored by the natural ingredients of the product portfolio. Can you outline a little of the product strategies, systems and synergies across your portfolio of products? Simon – Comvita manufactures, markets and distributes natural health and beauty products across four key broad market segments: health care, functional foods, personal care and medical. We operate across a range of key natural ingredient platforms, with our core business being Bee Products including UMF Manuka Honey and Propolis, and Fresh-Picked™ Olive Leaf Extract. Our Olive Leaf harvesting and manufacturing process is totally integrated. Our specialised on-site extraction facility enables the rapid extraction of freshly harvested olive leaf extract, so every drop is fresh-picked and then fresh-processed for packaging.

Professional Review

“Fresh Olive Leaf Extract and Medihoney are two primary product categories in the Comvita product portfolio across Pharmacy.”

We believe that an increasing number of consumers want to know and trust the source of their food and medicine supply. Over the long term, they will significantly reward companies and brands who can manage the total supply chain from harvest at source through to consumption.

Editor – In considering your new product development (NPD) process, could you share a little of this important function of the business? Simon – Our global operations focus is innovation as we look to build a demanddriven, vertically integrated supply chain — one that enables Comvita to grow faster and compete globally, while still maintaining the high quality experience for our consumers when they use our products. In Australia we are focused on getting to know our consumers intimately. We’re undertaking extensive consumer research to understand the meaning of wellness and the role of specific natural ingredients in improving health outcomes for our Australian consumers. This will help us to better explore potential new product development opportunities for our pharmacy portfolio.

Editor – Fresh Olive Leaf Extract and Medihoney are two primary product categories in the Comvita product portfolio across Pharmacy. Why have Comvita focused on these two products particularly? Simon – Fresh-Picked™ Olive Leaf Extract and MEDIHONEY® originated in Australia. Both categories have a strong brand heritage in Australian retail Pharmacy and have built a very loyal consumer following over the years. Our Fresh-Picked™ Olive Leaf Extract is arguably the best in the world. Being a freshpicked, fresh-processed product, as well as 100% Australian grown and made, is quite unique in the current market. In 2014 we introduced our 1 Litre Value Pack, our new High Strength One-a-day Capsules and our improved Extra Strength Liquid to better meet the needs of Olive Leaf consumers. These product launches have been very successful for Pharmacy, with early market data indicating these three SKUs will quickly become bestsellers.

We also re-launched our MEDIHONEY® Natural Eczema Care range in April at the APP Expo on the Gold Coast. We spoke to hundreds of Pharmacists and Pharmacy Assistants throughout the event and the response to the new and improved range was overwhelmingly positive.

Editor – Finally, are you able to share any specific goals or objectives for the business for the remainder of 2015 and beyond? Simon – Fresh-Picked™ Olive Leaf Extract and MEDIHONEY® will continue to be our primary focus for 2015. We’ve done a lot of work over the last twelve months to improve our Olive Leaf and MEDIHONEY® offerings and intend to lift our investment in marketing over the next twelve months to increase the growth of these two important market segments.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

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Contact Lease1: 1300 766 369 | pharmacy@lease1.com.au | www.lease1.com.au

down to business

Be prepared for the changes to

HIV antiretroviral therapy Jane Larter B.Pharm Pharmacist – Trainer and Assessor; Pharmacy Guild of Australia QLD

From 1 July 2015 eligible community based prescribers of HIV antiretroviral therapy will be able to prescribe without the need to demonstrate an affiliation with a hospital. The approval process to prescribe these medicines will be the same for all prescribers, with streamlined authority requirements applying to community, private and public based prescribers.

For community pharmacy it is vital to check that the appropriate ‘streamlined authority code’ has been included on the PBS prescription. These new arrangements will mean patients can access their medicines from the pharmacy of their choice, regardless where the medication was prescribed, improving access to life-saving therapy.

Why is this important? People with HIV can live long and healthy lives when they have access to treatment. There are now more than 20 antiretroviral drugs but, despite this, people with HIV face many barriers to accessing affordable

and effective HIV treatment. Taking HIV treatment requires effort and commitment as drugs must be taken at exact times each day. Some people may experience serious side effects or may not respond to certain drugs. Care and support can help people to adhere to treatment and address any problems they may have with their treatment regimen. The National HIV Strategy has set a target of an increase of treatment uptake to 90%. Achieving this target has required a more active approach to HIV. The change in policy better aligns community prescribing and the need for patient dispensing convenience —

“Care and support can help people to adhere to treatment and address any problems they may have with their treatment regimen.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

a position which has strongly been advocated by HIV activists over the last decade. An example of this is when people with HIV have returned to employment; they were required to take time off work to attend hospital pharmacies to collect their HIV medications, highlighting a need for evening and weekend dispensing.

Our involvement as pharmacists Community pharmacists are in a key position to raise awareness, provide education, assist people through side-effect management and decrease stigmatisation through the normalisation of the HIV treatment process. It is anticipated that pharmacies near HIV treatment centres, and with an established customer base with HIV, might stock some common HIV medications, with a majority of stock managed on a just-in-time basis. HIV antiretroviral drugs are very effective but they require regular dosing with 100% adherence as the goal. Many of the newer drugs have a longer half-life and so are more forgiving of an occasional missed or delayed dose; however, the pharmacist’s role is very important in explaining why it is important to take drugs as prescribed and the need to maintain a therapeutic drug level.

down to business

Adherence Forgetting, or being unable to fill prescriptions are the most common reasons given for treatment interruptions. It is therefore important that community pharmacies have the stock to supply their customers with their medications. How pharmacists go about this with their customers will largely be dependent on the pharmacist-customer relationship. Pharmacies close to HIV treatment centres, and with an established HIV customer base, might already stock some of the more common HIV medications, but the majority of pharmacies may have to look at the positives and negatives of keeping stock on hand versus managing stock on a just-in-time basis. Depending on the existing relationship with customers, pharmacists might want to offer to hold prescriptions, send SMS reminders, or offer adherence aids such as DAAs. It would also be of value to discuss with your local HIV s100 prescriber that you will be dispensing HIV antiretroviral drugs and to make sure to know which of your suppliers stock HIV medication.

“By actively promoting health of the individual and the community, pharmacists can enable people living with HIV to manage their overall health.”

•• Stigma can have a negative effect on the

Avoiding stigma and discrimination People with HIV generally suffer from fear of discrimination and this discrimination often occurs because of breaches of confidentiality. It is therefore very important to make sure that staff are aware and reminded of their privacy and confidentiality obligations. Some staff may have had limited exposure to HIV and may have concerns, therefore it is important to brief them and train them about HIV. The main points for staff to be aware of are:

•• HIV is only transmitted through blood-to-blood and intimate contact (i.e. sexual intercourse). •• They are not at risk from casual contact with a person living with HIV (e.g. accepting money).

quality of care customers receive and that they should not associate HIV with immoral behaviour.

Resources and more information By actively promoting health of the individual and the community, pharmacists can enable people living with HIV to manage their overall health. In preparation of this change it would be recommended that pharmacists review the antiretroviral therapy available and note that The Pharmacy Guild of Australia, Pharmaceutical Society of Australia and the Australian Government will be releasing vital resources closer to July outlining the changes that all pharmacists should be aware of.

HELPS KILL BACTERIA & RELIEVES SORE THROATS CHCANZ-BET-14-12-1169B-FEB-2015

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

ASMI24536-0215

PHARMACY ASSISTANT NATIONAL CONFERENCE 2015

15-17 OCTOBER 2015

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Send two pharmacy assistants to PA2015 and receive a FREE APP2016 registration for your pharmacy (value = $760)*

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down to business

Supporting the Health of Australia’s Ageing Population – How Pharmacists Can Promote

Healthy Ageing BY vanessa lontos Founder — The Care Project — Helping build health and wellness services in pharmacy

down to business

Australia’s population is growing and ageing — it is projected to grow from around 22 million people currently, to 35.9 million people in 2050. The ageing of the population will see the number of people aged 65 to 84 years more than double and the number of people 85 years and over more than quadruple.1 However, an ageing population does not necessarily mean a sicker population, in fact the baby boomer generation is projected to be healthier, more active and more productive than preceding generations.2

Pharmacists are uniquely placed to offer advice, support and encouragement to patients of all ages. Conversations around Healthy Ageing must become a focus area of pharmacy and a key pharmacist specialisation.

So what is healthy ageing? There are many definitions of healthy ageing, a term which is often used interchangeably with terms such as active ageing, successful ageing, positive ageing and productive ageing. Although there

is no universal definition, there is general acceptance that healthy ageing involves more than just physical or functional health.3 In simple terms, healthy ageing means older people are able to be independent and active participants in society.

Here are 3 ways you can support your patients to ensure they build a focus on healthy ageing:

Ask different questions

Don’t just focus on medication management

We often underestimate how powerful our questions are. Effective questioning is a key communication and relationship building technique. When done with intention, thoughtfulness and focus, the right question can help solve many problems and establish life-long therapeutic relationships. Have you ever stopped to really think about the questions you ask or do you repeat the same questions over and over again? While there are many questions that assist you in your clinical role — and you will need to ensure you keep asking those! — there are other questions that help you form connections with your patients. And it’s these connections that will help you build relationships with your patients that can encourage changes in lifestyle and quality of life. So instead of just asking, ‘Have you had this medication before?’, try these as well:

Yes, I did just say that! Research compiled by the National Ageing Research Institute (NARI) and Council on the Ageing (COTA) for the Victorian Department of Health4 suggests that in addition to medication management strategies, such as selfmanagement — health literacy, healthy eating, falls prevention and even education on alcohol and tobacco use are all important focus areas to help encourage healthy ageing. Create a small project or pilot a program within your pharmacy to raise awareness of the importance of healthy ageing. Just start with one step. The health of future and older generations depends upon our ability to continue to offer new and effective ways to promote health and wellbeing.

•• How are you managing your medications

1 2 3 4

at home at the moment? •• What else are you doing at home to help you achieve your health goals? •• We have a range of services here at the pharmacy to help promote healthy lifestyles. Would you like to hear more about them?

Become involved in your community — show you care

Stepping outside the dispensary is becoming a very important step for the emerging, modern-day pharmacist. Most of your best work can be achieved when you expand yourself and your influence in your local community. There is growing evidence that a multi-disciplinary approach greatly improves the health outcomes of patients. Which other people can you connect with in your local area, even just over a casual coffee chat, to start a conversation about how you together can promote healthy ageing? You can also think outside the square — a pharmacy I previously worked in regularly conducted health talks to a local retirement village. The residents absolutely loved it and felt immediately more connected to their local pharmacy.

Viewed at: http://hsc.csu.edu.au The Benefits of Ageing Report, The Australian Institute, Judith Healy, 2002. Health Ageing Lit Review Report, Victorian Government, 2012. Health Ageing Lit Review Report, Victorian Government, 2012.

“Pharmacists are uniquely placed to offer advice, support and encouragement to patients of all ages. Conversations around Healthy Ageing must become a focus area of pharmacy and a key pharmacist specialisation.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

Professional Review

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

Nearly 50% of people do not receive adequate pain relief with a simple analgesic, and many don’t respond, tolerate or want codeine1. The need in the community for a stronger pain relief without codeine is evident and products like Nuromol® with Synchro-Tech™ help pharmacists to fill this gap and better meet their customer’s needs.

ITK caught up with Pharmacist Consultant Gold Coast Medicare Locals Persistent Pain Project Manager, Joyce McSwan to discuss combination OTC analgesics, pain management and hear more about the efficacy and tolerability of new Nuromol® with Synchro-TechTM.

need for repeated and continued analgesic dosing. If repeat doses are not required it may contribute to an overall reduction in analgesic consumption. A codeine-free combination analgesic that achieves the same, if not better pain relief than codeine combinations, may result in fewer patients experiencing unwanted side effects.

Editor – How is Nuromol with SynchroTechTM different to other analgesics already available in pharmacy? Joyce – Recent evidence has shown us that the combination of ibuprofen and paracetamol in the unique Synchro-TechTM formulation efficiently combines both molecules together.5 What we see as a result

Editor – Why do we need combination OTC analgesics? Joyce – Two different active ingredients, such as paracetamol and ibuprofen, have different mechanisms and primarily targeting different pain pathways.2, 3 Whilst their mechanisms are different, the hypothesis is that their synergistic effects may result in better pain relief. Combination analgesics may also represent a more ‘dependable’ or effective option for a broader number of people. The most common combination OTC analgesic recommended in Pharmacists, by far, has been codeine combined with a simple analgesic. Codeine is metabolised differently by different people and not everyone can metabolise codeine into its pain relieving active form.4

“Having two simple analgesics combined in a fixed-dose formulation may provide faster and more effective acute pain relief.”

Having two simple analgesics combined in a fixed dose formulation may provide faster and more effective acute pain relief.

Editor – How does the launch of Nuromol® with Synchro Tech™ benefit people with acute pain? Joyce – The patented Synchro-TechTM formulation provides a faster onset of action which means that the acute pain occasion will be quickly controlled, avoiding the GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

Professional Review

“Pharmacists should be proactive in their conversations with patients and not assume that patients will won’t be interested in finding out about new options for managing acute pain.”

is faster drug bioavailability, evidenced in the pharmacokinetic studies, and better pain relief, compared to commonly used analgesics, by way of very good clinical studies.

Editor – What are the dosing benefits of Nuromol®? Joyce – In a clinical trial, one tablet of Nuromol® was seen to deliver significantly superior efficacy compared to two tablets of an S3 paracetamol/codeine combination.4 Normally a total daily dose of 1200mg ibuprofen and 4000mg paracetamol is recommended for the individual ingredients. Achieving better efficacy with lower doses of medicines, in this case 200mg Ibuprofen and 500mg paracetamol per dose for

maximum of 3 doses/day of Nuromol® with Synchro-Tech™, is consistent with QUM principals and supported by best practice guidelines.

Editor – How do you think pharmacists can better manage acute pain? Joyce – Pharmacists should be proactive in their conversations with patients and not assume that patients will won’t be interested in finding out about new options for managing acute pain. Finding out how they are treating their acute pain and if the treatment is effective or not is a critical first step. It is important where treatment is not working that something new is tried. It could be the dose, frequency and bioavailability that can contribute to a treatment working or not. Non-drug methods should also be suggested to support the effectiveness of analgesics.

Editor – Why is ongoing S3 and pain management education so important? How can pharmacists ensure their staff /pharmacy assistants are up to speed with the latest analgesics training? Joyce – Being able to supply S3 products assumes that an individual has a certain level

of education and accepts the responsibility as custodians of these medicines. Ongoing education is important as the pain management space is changing faster than ever before. If we are not on top of the game in our knowledge then how can we properly find solutions for our patients? The RB Health Hub pain-related training programs, including Pain Pod and the new Nuromol® CPD module, as well as other training available from the different pain bodies, such as Pain Australia, Australian Pain Society and Agency for Clinical Innovation – Chronic Pain are all very worthwhile resources. References: 1 Moore et al. Int J Clin Pract, January 2013, 67 (Suppl. 178), 21-25. 2 RB Data on file, January 2015. 3 Tanner T, et al. The pharmacokinetic profile of a novel fixed-dose combination tablet of ibuprofen and paracetamol. BMC Clin Pharmacol 2010;10:10. 4 Daniels SE, et al. A randomised, five-parallel-group, placebo-controlled trial comparing the efficacy and tolerability of analgesic combinations including a novel single-tablet combination of ibuprofen/ paracetamol for postoperative dental pain. Pain 2011;152(3):632–42. 5 Sherry R, inventor; Reckitt Benckiser Healthcare (UK) Limited, assignee. Composition comprising a NSAID and paracetamol. Australian patent 2012251941, 13 Nov 2012.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

training and education

Introducing Nuromol® ™ with Synchro-Tech One Powerful Little Package With its unique Synchro-Tech™ formulation, Nuromol® is the only paracetamol/ibuprofen combination clinically proven to deliver at least as much pain relief as S3 codeine-containing combinations.2,3,4,5

“In a clinical trial (Daniels et al. 2011) of patients with moderate–severe post-operative dental pain, one tablet of Nuromol® with Synchro-TechTM delivered significantly superior efficacy compared to two tablets of an S3 paracetamol/codeine combination.5”

Synchro-TechTM is a unique patented formulation technology available exclusively to Nuromol®2,3 which enables ibuprofen and paracetamol to dissolve simultaneously.6 Studies have also shown that the novel fixeddose combination provides fast pain relief4 which lasts up to eight hours.5 Each tablet of Nuromol® contains 500 mg of paracetamol and 200 mg of ibuprofen.1 In a clinical trial (Daniels et al. 2011) of patients with moderate–severe post-operative dental pain, one tablet of Nuromol® with Synchro-TechTM delivered significantly superior efficacy compared to two tablets of an S3 paracetamol/codeine combination.5 Taking one Nuromol® with Synchro-Tech™ tablet was also shown to be as effective as taking two ibuprofen/codeine tablets.5 Nuromol® with Synchro-Tech™ is scheduled Pharmacist Only (S3) and available in pack sizes of 12 and 24 tablets. Nuromol® with Synchro-Tech™ is effective for the temporary relief of acute pain and/ or inflammation associated with headaches, migraines, sinus pain, toothache, dental procedures, backache, muscular aches and pains, period pain, sore throat, tennis elbow, rheumatic pain and arthritis, and the aches and pains associated with colds and flu.1

REFERENCES 1 Nuromol Approved Product Information, June 2014. 2 Sherry R, inventor; Reckitt Benckiser Healthcare (UK) Limited, assignee. Composition comprising a NSAID and paracetamol. Australian patent 2012251941, 13 Nov 2012 3 Sherry R, inventor; Reckitt Benckiser Healthcare (UK) Limited, assignee. Composition comprising a NSAID and paracetamol. Australian patent 2006293798, 2006 Sept 07 4 Mehlisch DR et al. A single-tablet fixed-dose combination of racemic ibuprofen/paracetamol in the management of moderate to severe post-operative dental pain in adult and adolescent patients: a multicenter, two-stage, randomized, double-blind, parallel-group, placebo-controlled, factorial study. Clin Ther 2010;32(6):1033–49. 5 Daniels SE et al. A randomised, five-parallel-group, placebo-controlled trial comparing the efficacy and tolerability of analgesic combinations including a novel single-tablet combination of ibuprofen/paracetamol for postoperative dental pain. Pain 2011;152(3):632–42. 6 RB data on file, January 2015 GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

The recommended advice to patients is to take one Nuromol® with Synchro-TechTM tablet every 8 hours as necessary with a glass of water, and for no more than 3 days at a time.1 Nuromol® 12 pack RRP: $8.99 Nuromol® 24 pack RRP: $15.99

For more information on Nuromol® with Synchro-TechTM or to watch an interview with Professor Andrew Moore talking about the Synchro-TechTM difference, readers can visit www.rbhealthhub.com.au

training and education

Are you confident answering customer enquiries regarding

Natural Medicines with pharmaceuticals? It’s never been more crucial for today’s Pharmacist to understand Natural Medicines integration with pharmaceuticals.

The popularity and use of Natural Medicines is increasing in Australia. A recent study showed that 79% of Australians had used Natural Medicines in the last 12 months1 and 18% would try Natural Medicines before conventional medicine1. Ethical Nutrients has a strong commitment to supporting the use of Natural Medicines and believes education is the key to helping healthcare professionals recommend Natural Medicines alongside pharmaceuticals. Ethical Nutrients 2015 Natural Medicines for Today’s Pharmacist is an opportunity to join like-minded Pharmacists for a day of high quality, evidence-based learning and be at the forefront of the integrative medicine revolution.

What will this training cover? •• Practical strategies to integrate Natural Medicines with your prescribing

•• Front-of-shop as a new market and focus for revenue and profit driving •• The most commonly prescribed and highly researched evidence-based Natural Medicines •• Potential interactions that may occur between herbs/nutrients and drugs •• The largest growth categories in-store including probiotics, fish oil, menopause, pain relief, magnesium and iron

What will Pharmacists gain from attending? •• Confidence in recommending Natural •• ••

“Ethical Nutrients has a strong commitment to supporting the use of Natural Medicines and believes education is the key to helping healthcare professionals recommend Natural Medicines alongside pharmaceuticals.”

•• •• •• ••

Medicines alongside pharmaceuticals A comprehensive education pack, including a manual and technical data A renewed passion for community pharmacy Ethical Nutrients product samples valued at over $85 A healthy and delicious buffet lunch, plus tea and coffee A special gift for attending 8.5 Continuing Education and Development Points (CPD)/formal learning hours. Please enquire with your individual association for more details.

Ethical Nutrients products extensively in his practice and finds it invaluable for driving loyalty as his customers get results. Erika Mikl is the National Education Manager for Health World Limited and is a qualified Naturopath who has been involved in the field of Natural Medicine for over 20 years. Erika develops and presents market-leading retail education and training. Her focus is on developing and writing Ethical Nutrients Retail Training Evenings and the popular online learning modules.

Venues and dates for 2015: Brisbane

Monday 24 August at Novotel Brisbane

Sydney Wednesday 26 August at Novotel Sydney Central Adelaide

Monday 31 August at Rockford Adelaide

Perth Wednesday 2 September at Mercure Hotel Perth Melbourne

Monday 7 September at Novotel St Kilda

Launceston Wednesday 9 September at Hotel Grand Chancellor Investment $99 per attendee Training 9.00 am – 3.30 pm

Who will present the training? John Catsicas is a Pharmacist and Naturopath with extensive experience in nutritional and holistic medicine. Successfully running a busy compounding pharmacy, he compounds many nutritional formulas for both adults and children. John prescribes

Registration is essential. To register please phone Health World on 1800 777 648.

REFERENCES 1 Thompson P, Jones J, Browne M, Leslie S. Why people seek complementary and alternative medicine before conventional medical treatment: a population based study. Complement Ther Clin Pract. 2014:20(4):339-46. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

TRAINING AND EDUCATION

The Lowdown on Head Lice Head lice infestation is a constant worry for mums and dads. With around one in five primary school kids suffering from head lice at any one time , parents are on the hunt for an effective treatment.

Most parents will probably have to deal with head lice at some stage, and while they have a tendency to reappear, there is a way to help keep nits at bay.

WHAT ARE HEAD LICE? Head lice are tiny parasites that infest the hairs of the human head, feeding on small amounts of blood drawn from the scalp. While highly contagious, they are generally harmless and don’t spread disease. A single head lice is known as a louse, which hatches from an egg (also called a nit).

WHERE DO HEAD LICE COME FROM? Head lice have been around for thousands of years. Like any insect, they learn to adapt to their environment to survive, which makes them difficult to eradicate. Despite popular misconception, head lice do not ‘jump’ from head to head. They can only move directly from one person’s hair to hair on another head. Since they require blood from the human scalp to survive, it’s not likely that you’ll find head lice living in hats, clothes or carpets.

ARE HEAD LICE A SIGN OF POOR HYGIENE? Regardless of whether a child’s hair is short, long, clean or dirty, anyone can catch head lice. Home hygiene has nothing to do with infestation, but lice are most commonly found among children aged between 3–11.

belongings that touch their heads. This includes hats, hairbrushes, hair accessories, helmets, towels and even headphones. It’s also best for children to avoid activities that involve head-to-head contact. It always pays to have an effective treatment on hand at all times in case of an outbreak.

HOW CAN HEAD LICE BE TREATED? While there are many treatments available, not all products are effective or easy to use. LicenerTM has been tested in several clinical studies where it was shown to kill both head lice and nits (eggs) in one ten-minute treatment, with no combing required to ensure the effectiveness of the treatment. Plus, it’s gentle on normal skin and is suitable to use on children as young as two years old.

HOW DOES LICENER WORK? Licener contains an active ingredient called neem extract, which penetrates the aeropyles or ‘breathing holes’ at the top of the eggs, causing them to suffocate and die. The extract also immobilises and suffocates the lice inside and breaks down the protective shell of the eggs. Since Licener works with a physical mode of action, lice are unable to build resistance to the product.

IS THERE A WAY TO PREVENT HEAD LICE? While it’s likely that head lice will never completely be eradicated, we can make managing them easier. The spread of head lice can be prevented by ensuring children don’t share any

Mayne Pharma International Pty Ltd ABN 88 007 870 984

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

HOW MUCH TREATMENT IS NEEDED? The amount of treatment required will vary depending on the length of hair. For short hair, 50 ml will be sufficient, while longer hair will need 100 ml (one bottle). Consumers should always ensure enough treatment is used to cover the complete hair and scalp.

You can learn more about Licener Single Treatment at www.licener.com.au/pharmacy.

Always read the label. Use only as directed.

One in four Australian adults have bladder or bowel control problems. The good news is that the majority of cases can be cured or improved.

Information and confidential advice for health professionals and consumers is available from the freecall

National Continence Helpline 1800 33 00 66 8am to 8pm weekdays

More information and free downloadable resources in 27 languages are available at

continence.org.au

what’s new & company news ``DON’T JUST SURVIVE WINTER, THRIVE IN WINTER Comvita Australia, makers of Australia’s # 1 Fresh-Picked™ Olive Leaf Extract, is growing their range for Pharmacy. Like their olive trees, Comvita is committed to helping pharmacy businesses thrive in winter, and beyond. Comvita’s sales support program for pharmacy will see continued investment in product training, in-store activations and merchandising, as well as increased promotional activity support with a strong focus on the peak winter/spring immune season.

“With 1 in 3 women over age 35 experiencing light bladder leakage Poise® Active, is designed for use during exercise.”

Comvita’s range expansion program is also thriving. Following the success of the new 1 Litre Natural Flavour, Comvita will add Peppermint and Mixed Berry Flavours to the value pack offering. The new 1 litre pack sizes are popular in households where more than one person takes Fresh-Picked™ Olive Leaf extract, as they are extremely economical. The new 1 Litre packs will be available just in time for winter. Comvita is also stepping up their national consumer advertising campaign throughout

winter 2015. The campaign, which features high reach television and print advertising, supported by high frequency digital activity, is expected to connect Comvita to more than 1 million females aged 35+ during peak winter months. For more information, or to discuss new products or promotional opportunities, Pharmacies are encouraged to contact their Comvita Account Manager or Service Representative. >> www.comvita.com.au

``NEW to Poise is a range for the active woman With 1 in 3 women over age 35 experiencing

•• Odour Control – ABSORB-LOC®

light bladder leakage (lbl). Poise® Active,

granules lock away wetness and help prevent odour. •• Quick Dry Breathable Cover – For freshness and comfort.

is designed for use during exercise, offering discreet protection and up to 3x more absorbency than period-only products.

#Drier than feminine care ultrathin products when re-wet is compared against leading feminine care ultrathin products.

POISE® Active products are the thinnest and most discreet in the Poise range. The drawstring pack and individually wrapped range is for on the go lifestyle.

The range includes four product offerings

•• Discreet Active Protection – Thin, flexible,

•• Poise® Active Microliner – RRP $1.99 •• Poise® Active Microliner Long – RRP $1.99 •• Poise® Active Regular Ultrathin with Wings

drier# and more absorbent to keep you feeling protected and fresh during exercise.

•• Stays in Place – Secure attachment

– RRP $4.99

design helps you stay protected during

•• Poise® Active Super Ultrathin – RRP $4.99

movement.

>> www.poise.com.au

HELPS KILL BACTERIA & RELIEVES SORE THROATS CHCANZ-BET-14-12-1169B-FEB-2015

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

ASMI24536-0215

what’s new & company news

``Betadine launches new range of antibacterial

“Betadine now offers Betadine Sore Throat Lozenges an antibacterial, on the go solution for fast, soothing and effective relief from the discomfort of a sore throat.”

Sore Throat Lozenges

Betadine, Australia’s #1 sore throat gargle brand1 has launched new Betadine Sore Throat Lozenges to provide consumers with another option in their battle against a sore throat. ‘Australians told us they want an on the go solution for relief of sore throats,’ said Mike Abbott, Head of OTC Marketing and Innovation for Sanofi Consumer Healthcare (the Australian distributor of Betadine). ‘In response Betadine now offers Betadine Sore Throat Lozenges an antibacterial, on the go solution for fast, soothing and effective relief from the discomfort of a sore throat.’ Mr Abbott said Betadine Sore Throat Lozenges are a great companion product to Betadine Sore Throat Gargle.

‘People can use Betadine Sore Throat Lozenges throughout the day for effective relief and to help kill bacteria which can cause sore throat and minor mouth infection. Betadine Sore Throat Gargle can be used morning and night, which may treat the cause of a sore throat.’ In the lead up to the sore throat season in May, special offers will be available. Speak to your Sanofi Consumer Healthcare representative or call 1800 732 273. Betadine Sore Throat Lozenges come in three flavours, Soothing Honey & Lemon, Orange, Fresh Menthol & Eucalyptus. RRP $6.29 16 pack, $9.99 36 pack >> www.betadine.com.au

``Women missing warning signs of heart attack For most women the big fear is cancer, particularly breast cancer, but heart disease kills three times as many Australian women. In fact, it’s the biggest killer of women but many are missing the warning signals. Whilst men suffer twice as many heart attacks as women each year, almost the same number of men and women will die from them. Part of the reason women are less likely to survive is they’re slower to

recognise the warning signs of a heart attack, slower to seek help, and when they do get to hospital there is evidence to suggest they’re less likely to receive life saving treatment than men. Women are more likely to experience warning signs such as nausea, fatigue, shortness of breath, cold sweats, pain or discomfort in the jaw, hands, arms or back. These are symptoms that can be mistaken

for conditions such as the flu, overexertion or just feeling a ‘bit run down’ rather than a life-threatening heart attack. That’s why the Heart Foundation is pleading with Australian women to avoid becoming a statistic by doing two things – find out their risk of heart attack by visiting their GP for a heart health check and learn the warning signs by visiting: >> www.heartattackfacts.org.au

* Mid campaign tracking research conducted by Jigsaw Research, Sydney December 2014

Business directory

Business Directory AFT Pharmaceuticals Level 1, 296 Burns Bay Road Lane Cover NSW 2066 Tel: 02 9420 0420 >> www.aftpharm.com

Comvita 10 Edmondstone Street South Brisbane QLD 4101 Tel: 1800 466 392 >> www.comvita.com.au

Continence Foundation of Australia Level 1 30-32 Sydney Road Brunswick VIC 3056 Tel: 03 9347 2522 >> www.continence.org.au

Kimberly-Clark Australia 52 Alfred Street Milsons Point NSW 2061 Tel: 1800 028 334 >> www.kimberly-clark.com.au

RB Australia 44 Wharf Road West Ryde NSW 2114 Tel: 1800 226 766 >> www.rbhealthhub.com.au

Sanofi Consumer Healthcare LEASE1 Retailer House – Level 1, Unit 3 321 Kelvin Grove Road Kelvin Grove QLD 4059 Tel: 1300 766 369 >> www.lease1.com.au

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

87 Yarraman Place Virginia Qld 4014 Tel: 07 3212 8777 >> www.sanofi.com.au

Would you like to advertise in our new Business Directory?

Mayne Pharma FLOWSELL 1/13 Network Drive Carrum Downs VIC 3201 Tel: (61-3) 9708 2276 >> www.flowsell.com.au

Johnson & Johnson Pacific 45 Jones St Ultimo 2007 Tel: Consumer Care Centre 1800 029 979 >> www.nicorette.com.au

1538 Main North Road Salisbury South, SA 5106 Tel: 08 8209 2666 >> www.maynepharma.com

Paper-Pak Tel: 1800 088 258 >> www.paper-pak.net

Contact Jess O’Connor on Ph: 07 3040 4415 or Email: jessica.oconnor@goldx.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

PRODUCT SPOTLIGHT

PRODUCT SPOTLIGHT ``NEW Comvita Fresh-Picked™ Olive Leaf High Strength Capsules, One-a-day: These easy-to-take soft gel capsules are the only Olive Leaf capsule on the market made from Fresh-Picked™ extract, and are 100% Australian grown and made. Each capsule delivers 66mg of Oleuropein. When taken daily, can help support immune system function and maintain general wellbeing. RRP $28.95 60 Softgel Capsules >> www.olea.com.au or www.comvita.com.au

``THYROID ASSIST (NEW) – ONE A DAY TO ASSIST HEALTHY THYROID FUNCTION For customers looking to assist healthy thyroid function, Ethical Nutrients now has a comprehensive herbal and nutritional formula Thyroid Assist; containing milk thistle, rhodiola, ginger, rosemary, zinc, iodine and selenium. Thyroid Assist provides the key nutrients required for thyroid hormone production and to assist in healthy thyroid function. >> www.ethicalnutrients.com.au

``LicenerTM Single Treatment head lice shampoo LicenerTM Single Treatment is a new head lice shampoo that kills head lice and their eggs in just one application of 10 minutes with NO combing required ensuring the effectiveness of the treatment. Plus, it’s gentle on normal skin and is suitable to use on children over two years. Always read the label. Use only as directed >> www.licener.com.au/pharmacy

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

PRODUCT SPOTLIGHT

``Gaviscon Dual Action Gaviscon Dual Action brings fast, soothing and long lasting relief from the pain and discomfort of heartburn and indigestion. Gaviscon works by forming a raft that sits on top of the stomach contents to form a protective barrier and relieve discomfort and soothe the burning pain in the chest. RRP: Gaviscon Dual Action, 500ml bottle, $11.99. Chewable tablets, 16 pack, $4.99. 32 pack, $9.99 >> www.gaviscon.com.au

``Betadine Sore Throat Lozenges New Betadine Sore Throat Lozenges helps to kill the bacteria which can cause sore throats. Helps provide fast, soothing and effective relief from the discomfort of sore throats. Iodine free, available in great tasting soothing honey & lemon, fresh menthol & eucalyptus and orange flavours. Always read the label. Use only as directed. If symptoms persist, consult your healthcare professional. ASMI 24387-0115 >> www.betadine.com.au

``NICORETTE速 QuickMist NICORETTE速 QuickMist starts to act from 60 seconds* to give you fast relief from cigarette cravings. The nicotine is absorbed quickly into your body through the mouth lining, helping to rapidly relieve the urge to smoke. *2 x 1mg/sprays NICORETTE is a registered trademark

速

>> www.nicorette.com.au

``depend real fit underwear Almost 4.8 million Australians are affected by incontinence*. The good news, incontinence can be managed so you can feel like yourself again. With gender specific products Depend Real Fit is specifically designed to fit and feel like real underwear and protect against heavy loss of bladder control. RRP $12.99 - $25.99 *Source: Incontinence in Australia: prevalence, experience and cost, AIHW, Dec 2012 >> www.depend.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

Getting ready for QCPP accreditation? Meet QCPP training requirements with Guild Training All staff must complete initial and ongoing refresher training - Guild Training provides flexible learning delivered by experienced pharmacy professionals. Online training available Easy enrolment process

Efficient assessment timeframe Range of refresher training topics

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

www.guild.org.au/academy

TAS: 03 6220 2955 or tastraining@guild.org.au SA: 08 8304 8388 or trainingsa@guild.org.au NT: 08 8944 6900 or office@ntguild.org.au WA: 08 9429 4100 or training@wa.guild.org.au

PRODUCT SPOTLIGHT 60 SECONDS WITH...

I decided to become a pharmacist because... I worked with my uncle at his pharmacy when I was in high school and really enjoyed it. I realized then that I wanted to make a career out of it.

I have been working as a pharmacist for...

What I like best about my job is... Helping people with their health care needs and managing my own pharmacy.

When my wife and I went to Hamilton Island a few years ago. We got to snorkel in the Great Barrier Reef which was an amazing experience.

How I keep myself updated to the market news... Over the next 3 years in pharmacy, I predict... That pharmacists will be more involved in a wider array of professional services and this is particularly important as we see our dispensary margins continuing to shrink.

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

My favourite hobby is... Playing piano, especially learning David Side’s covers and weight training.

Day & Night Chemist @ Newtown

My best getaway ever was...

By reading pharmacy journals/magazines.

The past 8 years and have been operating my own pharmacy for the last three years.

Ibrahim Edelbi

My favourite book is... 1984 by George Orwell.

To not only focus on playing the pharmacist role but to gain experience about the business aspect of pharmacy as its just as important now and especially in the future considering PBS reforms.

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

Have your customers recently taken antibiotics?

Do your customers suffer from gas or bloating?

Want to improve general wellbeing?

Want to maintain healthy digestion and immunity?

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

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

IHP2877 - 01/14 /14 1

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

www.innerhealth.com.au

After Hours

AFTER HOURS...

neetdtle a liishment?

nour

holesomeness provides the most convenient way to eliminate processed food from your diet, by supplying fully prepared whole food meals, cooked to perfection by experienced gourmet chefs who are passionate about good food, and delivering these delicious meals to your door! Inspired by the Wholefood and Paleo Lifestyle, Wholesomeness believes the food we eat today should be recognised by our greatgrandmothers as actual food! > wholesomeness.com.au

Welcome to Wholesomeness Wholesomeness understands that meals are not what they used to be, whether it’s an active lifestyle, an unexpected (or planned) busy period, illness, or just the daily struggle. We don’t always have the luxury of time to prepare our meals or sit around a table and eat them together. However, we still need to eat good food that is nutrient dense and delicious, to live long and healthy lives. Food is not what it used to be either — just take a look around your local supermarket. The manufactured food industry is controlled by big brands and they don’t really care if it makes you sick or not — their concern is whether the shareholders make a profit. That sometimes means substituting real ingredients with unnatural concoctions that can build up in your system, cause allergies, can taste bad and make you reliant (or addicted) to their products.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

Wholesomeness firmly believes that food is ‘medicine’ and that eating delicious, whole, nourishing organic foods will lead to a healthier you. It is also important to them as a family business that it doesn’t cost the earth either, which is why they use locally grown, seasonal produce to keep prices as low as possible and to ensure food is at its prime when cooked and delivered to your door. Delivered three times per week, this home delivery system provides the most convenient way to eliminate processed food from your diet, by supplying whole foods cooked to perfection by experienced gourmet chefs who are passionate about good food.

After Hours

Try Wholesomeness if you need a little nourishment delivered to you, by ordering online today

wholesomeness.com.au

Come visit us! Wholesomeness has been chipping away at creating the healthiest convenience food delivery service in South East Queensland and has recently opened a bricks-andmortar shopfront in Brisbane’s inner north suburb, Grange. With some fantastic healthy food options — think protein balls, green smoothies and substantial daily salads — you can also pick up tonight’s fully prepared dinner from the display cabinet.

“

We are inspired by the Paleo/Primal Lifestyle template and think the food we eat today should be recognised by our great-grandmothers as actual food. We also respect The Perfect Health Diet, and don’t use sugar or preservatives in anything, and we include a range of healthy fats (omega 3s etc.) in every meal. We also firmly believe that we should all ‘Eat More Plants’ and have an interest in integrated health. If you eat more of the good stuff, there’s no room left for the bad stuff! Georgia Limmer, owner

Drop by for an All Day Breakfast of Pulled Pork, Sweet Potato Roesti and Dukkah Poached Eggs on Spinach. Or for a meatfree meal, try the Field Mushroom and Greens Omelette — all meals are gluten and dairy-free. Coffee is from specialty local roasters Rouge Coffee and our smoothies are made even more awesome with Amazonia RAW protein, pre-biotic, energising and greens powders. PLUS we use their organic Acai too. Wholesomeness is not only an organic wholefood delivery service, nourishing families across Brisbane and South East Queensland, a café and takeaway food shop, they also stock prepared meals to family owned Drakes Supa IGAs and boutique gyms. You can even have your event catered, with on-trend healthy delights.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

Health Destination Hub

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

NEW ITKCONNECT.COM.AU

ITK Connect is a new electronic medium designed to interface with community pharmacists on a host of professional, business and industry related topics. The objective is to position content

To register or find out more, please go to

directly to pharmacists in a

www.itkconnect.com.au we would be

timely and consistent format

pleased to include you on our mailing list.

electronically. ITK Connect will be distributed on the alternate month to ITK at no charge, with July.

C O N N E C T

HEALTH CALENDAR

HEALTH CALENDAR JUNE / JULY 2015

Bowel Cancer Awareness Month 1st – 30th June Bowel Cancer Awareness Month is an annual initiative of Bowel Cancer Australia running throughout the month of June (1 - 30 June 2014), 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. >> www.bowelcancerawarenessmonth.org

World Blood Day 14th June World Blood Donor Day, celebrated on 14 June every year, serves to raise awareness of the need for safe blood and blood products and to thank voluntary unpaid blood donors for their life-saving gifts of blood. The focus of this year’s World Blood Donor Day campaign is “Safe blood for saving mothers”. Every day, about 800 women die from pregnancy or childbirth-related complications. Severe bleeding during delivery and after childbirth is a major cause of mortality, morbidity and long-term disability. The goal of the campaign is to increase awareness about why timely access to safe blood and blood products is essential for all countries as part of a comprehensive approach to prevent maternal deaths.

National Tree Day 26th July National Tree Day and Schools Tree Day combine to make Australia’s largest community tree-planting and nature care event. Co-ordinated by Planet Ark and proudly sponsored by Toyota Australia, Tree Day is an opportunity to do something positive for your local environment and community and to reconnect with nature. National Tree Day started in 1996 and since then more than 3 million people have planted 21 million trees and plants. >> www.treeday.planetark.org

Red Nose Day 26th July Red Nose Day, held annually on the last Friday in June, is the major fundraiser for SIDS and Kids. Funds raised through Red Nose Day activities assist SIDS and Kids in providing vital services and programs to the Australian community. SIDS and Kids is dedicated to saving the lives of babies and children during pregnancy, birth, infancy and childhood and to supporting bereaved families. >> www.rednoseday.com.au

>> www.centenary.redcross.org.au

Dry July International Men’s Health Week 2015

1st – 31st July

Men’s Health Week is all about celebrating the many and wonderful contributions that boys and men bring to our lives. And it’s about celebrating the many everyday achievements in our lives as boys and as men, which in turn provides opportunities to think about our health and our wellbeing in a positive way. This idea of celebration is about valuing boys and men and their everyday successes. Improving men’s health requires an approach that engages boys and blokes.

Dry July is a fundraiser that challenges you to go booze-free for a month to support adults living with cancer. It helps you get healthy and clear your head while also raising funds for an important cause. Dry July improves the wellbeing of adult cancer patients by providing funds to create better services and environments for them and their families. Dry July takes a lighter-hearted approach to raising funds for a serious issue. You don’t often get the chance to raise money for charity by not doing something! It is a challenge of determination that rewards participants with a great sense of achievement and feeling of wellbeing.

>> www.menshealthweek.org.au

>> au.dryjuly.com

15th – 21st June

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 42 : JUNE/JULY 2015

MAKE THE SWITCH

TO MAXIGESIC

MAXIGESIC® is the only combination analgesic that delivers the maximum recommended daily OTC dose of Paracetamol 4000mg and Ibuprofen 1200mg, if required.* HARTLEY ATKINSON, Pharmacologist and Inventor of MAXIGESIC®

} MAXIGESIC® DELIVERS MORE MAXIGESIC® delivers 2.7 times more Paracetamol and 2 times more Ibuprofen than Nuromol®** at maximum recommended daily dosage, if required.* } PROVEN EFFECTIVENESS Clinically proven to reduce pain levels by at least 32% more than a full daily OTC dose of either Paracetamol or Ibuprofen alone1. } SIMPLE, FLEXIBLE DOSAGE REGIMEN 1–2 tablets up to 4 times per day, if required, offers flexibility and control in managing daily pain

* 2 tablets of MAXIGESIC® taken every 6 hours over a 24 hour period ** Nuromol® is a registered trademark of Reckitt Benckiser Group PLC

Please review the full Product Information before recommending, available at www.maxigesic.com.au

DOUBLE ACTION PAIN RELIEF WITHOUT CODEINE 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. Patent No. 2005260243.

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!

ISSUE #42 : JUNE / JULY 2015

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

• TEXT TO COME

IN THE KNOW AS SEEN ON TV • Relieve symptoms of colds and flu • Reduce the severity and duration of colds and flu • Support healthy immune function

YOUR NATURAL BUSINESS PARTNER ETH7245 - 04/15