tag:theconversation.com,2011:/us/topics/pharmacists-4212/articlesPharmacists – The Conversation2024-03-26T17:01:41Ztag:theconversation.com,2011:article/2257152024-03-26T17:01:41Z2024-03-26T17:01:41ZMany drugs are prescribed for conditions they weren’t tested for – here’s what you need to know<p>All prescription drugs need a licence from a regulator to treat a specific condition. But licensed drugs can be prescribed for conditions they haven’t been tested for in a clinical trial. This is known as “off-label” prescribing – and it’s very common.</p>
<p>The UK doesn’t have current figures on overall off-label prescribing, but a <a href="https://pubmed.ncbi.nlm.nih.gov/16682577/">US study</a> found that one in five prescriptions was off label.</p>
<p>It is important to note that off-label medicine use is not the same as experimental use. Legally, once a medicine has obtained a licence, it can be used for any condition in any patient. A licence is evidence a medicine is safe, effective and of good quality. </p>
<p>So why is off-label prescribing so common? This practice is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/">most common in</a> children, older people, pregnant women and psychiatric patients, usually with changes in dosing and formulations. It is unusual for drugs to have been tested in these groups of patients. </p>
<p>Obtaining a new license for a medicine (to treat a different condition) is time-consuming, often taking up to <a href="https://www.nature.com/articles/3901619#Sec2">eight years</a> to get approval. It is also very expensive, with the new revenue for the additional uses often not being enough to offset the cost of running new clinical trials, marketing and re-labelling the drug.</p>
<p>To determine if a medicine can and should be prescribed off-label, a prescriber may consider several factors. There may be common features in two similar conditions that ensure there should be a degree of cross-effectiveness. For example, a medicine licensed for anxiety might reasonably be used to treat post-traumatic stress disorder. And a drug approved to treat one type of cancer could reasonably be expected to target other types of cancer. </p>
<p>Some off-label uses have been found by accident. <a href="https://www.migraineagain.com/beta-blockers-migraine-prevention/">Beta-blockers</a> were licensed in the 1960s to treat heart conditions. People who were prescribed these drugs and who suffered from migraines found that their migraine symptoms improved after they started taking the drug. Today, these drugs are commonly prescribed for migraine.</p>
<p>On occasion, off-label medicine use can become the primary treatment option for a particular condition. Amitriptyline, an older type of antidepressant, is now often used to treat nerve pain.</p>
<p>Usually, a prescriber will have considered all other medical options for a patient and will have reviewed the evidence to support any off-label prescribing. This includes “evidence summaries” provided by the <a href="https://cks.nice.org.uk/about/">National Institute for Health and Care Excellence</a>. These are available to GPs to support safe decision-making. </p>
<p>The summaries look at current guidelines and reviews as well as research studies, such as clinical trials and observational studies, and expert opinions. Although the guidelines mainly focus on licensed drugs, they also discuss off-label uses that are common in practice. </p>
<p>Some off-label drugs may also be listed in the British National Formulary, a reference book that contains prescribing information about drugs available in the UK.</p>
<h2>Great responsibility</h2>
<p>Whether there is a wealth of evidence or not, there is a greater responsibility for the prescriber when prescribing drugs off label. </p>
<p>One risk is the absence of information from the patient leaflet. The metformin patient leaflet, for instance, discusses its use in diabetes, but there is no information about its alternative use to treat polycystic ovary syndrome, which can confuse patients. </p>
<p>A bigger risk is the incidence of side-effects, which increase when off-label prescribing is not based on strong medical evidence. Alternatively, the drug may not work at all. </p>
<p>Despite being strongly advocated at the time by some doctors and politicians, a <a href="https://www.nature.com/articles/s41467-021-22446-z">2021 review</a> debunked the use of hydroxychloroquine to treat COVID and found an increased risk of death with its use.</p>
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Read more:
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<p>Recently, <a href="https://www.diabetes.org.uk/about-us/news-and-views/ozempic-and-weight-loss-facts-behind-headlines#:%7E:text=People%20with%20type%202%20diabetes%20who%20use%20Ozempic%20can%20lose,you%20stay%20full%20for%20longer.">Ozempic</a> (semaglutide) caused a storm, with celebrities promoting its miraculous weight-loss effects. This off-label prescribing has led to continuing drug shortages affecting people with diabetes. But it also to the development of Wegovy for weight loss.</p>
<h2>No legal duty</h2>
<p>While there is no legal duty to tell a patient they have been prescribed an off-label medicine, prescribers follow professional guidelines. These state it is good practice to tell patients if a drug is being prescribed off label. </p>
<p>Patients should be told information about the medicine, including potential side-effects and the reasons why they have been prescribed an off-label medicine versus a licensed medicine.</p>
<p>A patient who has been told or suspects their medicine is off-label should ask why they have been prescribed this medicine and what the risks versus the benefits are. They could ask what the likelihood is of this medicine working and what might happen if they do not have the medicine. </p>
<p>Off-label drugs do not have the same medical evidence as licensed drugs and inappropriate use could lead to more side-effects. However, for some people, off-label drugs could be the best or only option and they must receive honest and accurate information about their treatment.</p><img src="https://counter.theconversation.com/content/225715/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dipa Kamdar does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There is no legal duty to tell a patient they have been prescribed a drug ‘off label’.Dipa Kamdar, Teaching Fellow in Pharmacy Practice, Kingston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2249622024-03-20T00:08:53Z2024-03-20T00:08:53ZNow you can get UTI antibiotics from pharmacies without prescription. Here’s what to know<figure><img src="https://images.theconversation.com/files/581151/original/file-20240312-29-6jfwhi.jpg?ixlib=rb-1.1.0&rect=18%2C37%2C6164%2C4078&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmacist-giving-medicine-box-customer-pharmacy-1785830159">Shutterstock</a></span></figcaption></figure><p>Urinary tract infections can be a minor medical annoyance or lead to a hospital stay – especially for older people.</p>
<p>If you think you might have a urinary tract infection (UTI) you need prompt advice and often antibiotics. But it can be <a href="https://www.abc.net.au/news/2023-06-21/urgent-gp-appointments-difficult-to-get-in-regional-rural-areas/102496354">difficult to get an appointment</a> with your doctor at short notice, especially in rural areas. </p>
<p>Now trained <a href="https://www.guild.org.au/guild-branches/wa/business-support/uti">pharmacists</a> in most Australian states are able to review your symptoms and supply antibiotics if appropriate. </p>
<p>But there are still times when you should see a doctor.</p>
<h2>What is a UTI? And when is it serious?</h2>
<p>The <a href="https://training.seer.cancer.gov/anatomy/urinary/components/">urinary tract</a> consists of the kidneys, ureters, and bladder and urethra. It’s the body system responsible for producing, storing and removing urine from the body. </p>
<p>When bacteria invade the urinary system – mostly from the bowel or the skin – they can multiply and cause infection. </p>
<p>Roughly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502976/">half of all women</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502976/">one in 20 men</a> will have a UTI at least once in their lifetime. The risk increases with age. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502976/">One in ten</a> postmenopausal women report having a UTI in the last year.</p>
<p>Typical signs of infection include a painful or burning sensation when urinating, feeling like you need to urinate urgently and often and cloudy or foul-smelling urine. In more severe cases symptoms can include fever, lethargy and pain in the lower back. </p>
<p>In older adults, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9827929/#:%7E:text=Delirium%20is%20a%20common%20atypical,and%20complex%20relationship%20between%20them.">UTIs can cause confusion, agitation and falls</a>.</p>
<p>For some people, UTIs can have <a href="https://www.ncbi.nlm.nih.gov/books/NBK482344/">serious complications</a>, such as kidney damage, kidney failure or infection in the blood (sepsis), particularly if treatment is delayed. </p>
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Read more:
<a href="https://theconversation.com/why-do-i-keep-getting-urinary-tract-infections-and-why-are-chronic-utis-so-hard-to-treat-223008">Why do I keep getting urinary tract infections? And why are chronic UTIs so hard to treat?</a>
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<h2>A common reason for hospital admission</h2>
<p>UTIs are the <a href="https://www.safetyandquality.gov.au/our-work/healthcare-variation/fourth-atlas-2021/chronic-disease-and-infection-potentially-preventable-hospitalisations/24-kidney-infections-and-urinary-tract-infections">second most common</a> cause of preventable hospital visits in Australia. Across the country they are <a href="https://outbreakproject.com.au/2020/11/17/australias-multi-billion-dollar-superbug-crisis/">reported</a> to result in 100,000 emergency department visits and 75,000 hospital stays each year. </p>
<p>The rate of hospitalisation for UTIs for Aboriginal and Torres Strait Islander people is around <a href="https://www.safetyandquality.gov.au/our-work/healthcare-variation/fourth-atlas-2021/chronic-disease-and-infection-potentially-preventable-hospitalisations/24-kidney-infections-and-urinary-tract-infections">double</a> the rate for other Australians. People aged over 65 years are <a href="https://www.safetyandquality.gov.au/our-work/healthcare-variation/fourth-atlas-2021/chronic-disease-and-infection-potentially-preventable-hospitalisations/24-kidney-infections-and-urinary-tract-infections">five times</a> more likely to be hospitalised with a UTI than younger Australians.</p>
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<a href="https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="older woman sits on couch and shows pained expression, clutches lower stomach" src="https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Older people are much more likely to be hospitalised with a UTI.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-elderly-senior-woman-stomach-ache-2391031945">Shutterstock</a></span>
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<h2>A quicker option</h2>
<p>The newly rolled out pharmacist consultations do not replace the option of visiting your GP. But they do provide an additional choice.</p>
<p>In <a href="https://statements.qld.gov.au/statements/95679">Queensland</a>, <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs+and+practice+guidelines/medicines+and+drugs/sa+community+pharmacy+uti+services/sa+community+pharmacy+uti+services#:%7E:text=From%201%20March%202024%2C%20eligible,a%20prescription%20from%20a%20doctor.">South Australia</a> and <a href="https://www.health.wa.gov.au/Articles/S_T/Treatment-of-urinary-tract-infection-by-pharmacists">Western Australia</a> the legislation has been changed to allow pharmacists to supply antibiotics to treat women (or people with female anatomy) aged 18 to 65 years with uncomplicated UTIs.</p>
<p>In <a href="https://www.health.nsw.gov.au/pharmaceutical/Pages/pharmacy-trial-uti.aspx">New South Wales</a>, the <a href="https://www.health.act.gov.au/health-professionals/pharmaceutical-services/act-pharmacy-uti-and-oral-contraceptive-pill-trial">ACT</a>, <a href="https://www.premier.vic.gov.au/pharmacists-delivering-accessible-health-care-victorians">Victoria</a> and <a href="https://www.health.tas.gov.au/pharmacyscope">Tasmania</a> trials allowing pharmacists to treat UTIs in the same patient group are underway or have been announced.</p>
<p>This approach to provide accessible and timely treatment options for UTIs through pharmacies aligns with that in <a href="https://www.psnz.org.nz/healthservices/utis">New Zealand</a>, the <a href="https://www.england.nhs.uk/long-read/launch-of-nhs-pharmacy-first-advanced-service/">United Kingdom</a> and <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwibvafH0OOEAxV4plYBHU9RBeEQFnoECBsQAQ&url=https%3A%2F%2Fwww.pharmacists.ca%2Fcpha-ca%2Fassets%2FFile%2Feducation-practice-resources%2FUncomplicated_UTI.pdf&usg=AOvVaw1E6EnFunmJRdVF8wD_AxuN&opi=89978449">Canada</a>. </p>
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Read more:
<a href="https://theconversation.com/cranberry-juice-can-prevent-recurrent-utis-but-only-for-some-people-203926">Cranberry juice can prevent recurrent UTIs, but only for some people</a>
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<h2>Not for everyone</h2>
<p>State guidelines direct pharmacists to only provide antibiotics to women (or people with female anatomy) aged 18 to 65 years with uncomplicated UTIs. If the pharmacist finds warning signs for a serious infection, or a complicated UTI, you will be referred for further consultation with a doctor. </p>
<p>Under this program, UTIs that occur in people who have an anatomically male urinary tract, are under 18 years or over 65, or are pregnant would be considered to have complicated UTIs, and such patients would be referred to their doctor.</p>
<p>Some other situations where UTIs are considered <a href="https://www.health.wa.gov.au/Articles/S_T/Treatment-of-urinary-tract-infection-by-pharmacists">complicated</a> and should be assessed by a doctor include when they occur in people with kidney disease, urinary catheters, a condition that weakens the immune system (such as diabetes, cancer or HIV) or reoccurring symptoms. </p>
<p>To supply antibiotics for UTI treatment pharmacists are required to undertake additional training. Pharmacists can only prescribe antibiotics according to an agreed evidence-based treatment guideline, <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/b52bbef1-4fed-4502-96ed-3ebf97ebdee1/Community+Pharmacy+UTI+Service+SA+Management+Protocol+-+Final1.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-b52bbef1-4fed-4502-96ed-3ebf97ebdee1-oRYPyBR">such as South Australia’s</a>. </p>
<p>Pharmacists will assess if you are eligible for the pharmacy UTI service and ask specific questions to check your symptoms match those of an uncomplicated UTI or for warning signs you need to see a doctor. If treatment is appropriate, they will ask questions about your medical and medication history to determine which type of antibiotic is most suitable for you.</p>
<p>Pharmacists will not test urine for bacteria, as Australian guidelines state antibiotic treatment <a href="https://tgldcdp.tg.org.au/searchAction?appendedinputbuttons=UTI">can be started</a> for women with uncomplicated UTIs straight away. If your symptoms or history suggest urine testing might be required the pharmacist will refer you to a doctor. </p>
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<a href="https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="medical clinicians holds urine test and indicator" src="https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Pharmacists won’t test urine samples.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-doing-test-strip-labstix-urine-1493181821">Shutterstock</a></span>
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<p>You can get a record of the consultation that you can share with your doctor. The requirements for documentation differ in different states but pharmacists can upload information to <a href="https://www.digitalhealth.gov.au/initiatives-and-programs/my-health-record">My Health Record</a> (if you haven’t opted out and are happy for them to do so).</p>
<p>This new service is not without <a href="https://theconversation.com/should-pharmacists-be-able-to-prescribe-common-medicines-like-antibiotics-for-utis-we-asked-5-experts-195277">controversy</a>. GPs have expressed concerns about misdiagnosis and <a href="https://theconversation.com/do-you-really-need-antibiotics-curbing-our-use-helps-fight-drug-resistant-bacteria-217920">antimicrobial resistance</a> where the bacteria could evolve and become much harder to treat. Detailed procedures have been developed for pharmacists to minimise these risks. </p>
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Read more:
<a href="https://theconversation.com/do-you-really-need-antibiotics-curbing-our-use-helps-fight-drug-resistant-bacteria-217920">Do you really need antibiotics? Curbing our use helps fight drug-resistant bacteria</a>
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<h2>What else can you do?</h2>
<p>While taking antibiotics to <a href="https://www.healthdirect.gov.au/urinary-tract-infection-uti">treat a UTI</a> you should also <a href="https://www.continence.org.au/urinary-tract-infection-uti">drink lots of water</a> and ensure you empty your bladder completely every time you go to the toilet.</p>
<p>Pain relievers can help ease discomfort from a UTI. But it’s important to speak with your pharmacist or doctor to find the best pain management option for you.</p><img src="https://counter.theconversation.com/content/224962/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacinta L. Johnson is employed as the Senior Pharmacist for Research within SA Pharmacy and is a Board Director for the Society of Hospital Pharmacists of Australia. In the last five years, she has received research funding or consultancy funds (for development and delivery of educational materials) from SA Health, the Medical Research Future Fund, the Hospital Research Foundation – Parkinson's, the Pharmaceutical Society of Australia, the Pharmacy Guild of Australia, the Society of Hospital Pharmacists of Australia, the Australian College of Pharmacy, Mundipharma Pty Ltd, Aspen Pharmacare Australia Pty Ltd, Reckitt Benckiser (Australia) Pty Ltd and Viatris Pty Ltd. Jacinta has not received funding from any organisation related to pharmacist consultations for provision of antibiotics for urinary tract infections.</span></em></p><p class="fine-print"><em><span>Wern Chai does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Older people and Aboriginal and Torres Strait Islander people are at much greater risk of hospitalisation from UTI. Prompt medical care is important.Jacinta L. Johnson, Senior Lecturer in Pharmacy Practice, University of South AustraliaWern Chai, Lecturer in Pharmacy and Pharmacology, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2130712023-09-20T05:57:51Z2023-09-20T05:57:51ZHow do hay fever treatments actually work? And what’s best for my symptoms?<figure><img src="https://images.theconversation.com/files/549215/original/file-20230920-21-6mbsm0.jpg?ixlib=rb-1.1.0&rect=9%2C224%2C6221%2C3895&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/ill-upset-african-woman-blowing-running-1444224848">Shutterstock</a></span></figcaption></figure><p>Spring has sprung and many people are welcoming longer days and more time outdoors. But for <a href="https://www.aihw.gov.au/reports/chronic-respiratory-conditions/allergic-rhinitis-hay-fever/contents/allergic-rhinitis">almost one in five Australians</a>, spring also brings the misery of watery, itchy red eyes, a runny, congested nose, and sneezing. </p>
<p>Hay fever (also known as allergic rhinitis) is caused when an allergen enters the nose or eyes. Allergens are harmless airborne substances the body has incorrectly identified as harmful. This triggers an immune response, which leads to the release of inflammatory chemicals (mediators) – one of which is histamine.</p>
<p>Allergens that trigger hay fever differ from person to person. Common seasonal allergens include tree, grass and weed pollens (year-round allergens include dust mites, mould and pet dander). It’s now <a href="https://www.sciencedirect.com/science/article/pii/S132602002302191X">pollen season</a> in many parts of Australia, with pollen counts at their highest and hay fever cases surging. </p>
<p>So what medicines can prevent or reduce hay fever symptoms, and how do they work?</p>
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Read more:
<a href="https://theconversation.com/do-i-have-covid-or-hay-fever-heres-how-to-tell-188030">Do I have COVID or hay fever? Here’s how to tell</a>
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<h2>Antihistamines</h2>
<p>Knowing the release of histamine is a cause of hay fever symptoms, it’s unsurprising that <em>anti</em>-histamines are one of the most frequently recommended medicines to treat hay fever. </p>
<p>Antihistamines block histamine from binding to histamine receptors in the body and having an effect, reducing symptoms.</p>
<p>In Australia, we broadly have two types. The older sedating (introduced in the <a href="https://www.tga.gov.au/news/safety-alerts/first-generation-antihistamines-winter-warning">1940s</a>) and newer, less-sedating (introduced in the 1980s) antihistamines. </p>
<p>Less-sedating antihistamines used to treat allergic rhinitis include bilastine (Allertine), cetirizine (Zyrtec), loratadine (Claratyne) and fexofenadine (Telfast). Bilastine, which came onto the Australian market only last year, is only available from a pharmacy, on recommendation from a pharmacist. The others have been around longer and are available at supermarkets and in larger quantities from pharmacies. Cetirizine is the <a href="https://www.tga.gov.au/resources/publication/scheduling-decisions-interim/scheduling-delegates-interim-decisions-and-invitation-further-comment-accsacms-november-2016/35-cetirizine-hydrochloride#:%7E:text=Risks%20of%20cetirizine%20hydrochloride%20use,significant%20at%20the%20proposed%20doses.">most likely</a> (of the less-sedating antihistamines) to cause sedation.</p>
<p>The older sedating antihistamines (such as promethazine) cross the blood-brain barrier, causing drowsiness and even brain fog the next day. They have lots of side effects and potential drug interactions, and as such have little place in the management of hay fever. </p>
<p>The newer less-sedating antihistamines are <a href="https://australianprescriber.tg.org.au/articles/antihistamines-and-allergy.html#:%7E:text=Less%20sedating%20antihistamines%20are%20equally,an%20ongoing%20good%20safety%20profile">equally effective</a> as the older sedating ones.</p>
<figure class="align-center ">
<img alt="Woman with red eyes touches her face" src="https://images.theconversation.com/files/549218/original/file-20230920-29-y20eo4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549218/original/file-20230920-29-y20eo4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549218/original/file-20230920-29-y20eo4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549218/original/file-20230920-29-y20eo4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549218/original/file-20230920-29-y20eo4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549218/original/file-20230920-29-y20eo4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549218/original/file-20230920-29-y20eo4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Hay fever can cause watery, itchy red eyes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-on-young-woman-inflamed-eyes-2271555335">Shutterstock</a></span>
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<p>Antihistamines are usually taken orally (as a tablet or solution) but there are also topical preparations such as nasal sprays (azelastine) and eye drops. Antihistamine nasal sprays have <a href="https://www.sciencedirect.com/science/article/abs/pii/S108112061000743X">equal to or better efficacy</a> than oral antihistamines.</p>
<p>The individual response to antihistamines varies widely. For this reason, you may need to trial several different types of antihistamines to see which one works best for you.</p>
<p>Increasing the dose of an antihistamine, or combining an oral and topical antihistamine, does not provide any additional benefit. Paying extra for a brand name doesn’t offer any more or less effect than the generic (both have the same active ingredient and are <a href="https://www.tga.gov.au/news/news/generic-prescription-medicines-fact-sheet">bioequivalent</a>, which means they have the same outcomes for patients).</p>
<h2>Steroid nasal sprays</h2>
<p>If your symptoms don’t improve from antihistamines alone, a nasal spray containing a corticosteroid is often recommended. </p>
<p>Corticosteroids prevent the release of several key chemicals that cause inflammation. How they work is complex: in part, corticosteroids “turn off” the production of late phase inflammatory mediators (cytokines and chemokines). This reduces the future release of more inflammatory mediators, which reduces inflammation.</p>
<p>Corticosteroids and antihistamines have different mechanisms of action. Research shows corticosteroid nasal sprays are <a href="https://journals.sagepub.com/doi/full/10.2500/ajra.2016.30.4397">more effective</a> than antihistamines in controlling an itchy, runny, congested nose. But when instilled into the nose, corticosteroids <a href="https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1016/j.otohns.2007.10.027">also reduce</a> the eye symptoms of hay fever. </p>
<p>There are also nasal sprays that contain both an antihistamine and corticosteroid. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/sneezing-with-hay-fever-native-plants-arent-usually-the-culprit-190336">Sneezing with hay fever? Native plants aren't usually the culprit</a>
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<p>While there are a range of corticosteroid nasal sprays containing different active ingredients, a large study published this year shows they are all <a href="https://www.frontiersin.org/articles/10.3389/fphar.2023.1184552/full">about as effective as each other</a>, and work best when they have been taken for several days. </p>
<h2>Sodium cromoglycate</h2>
<p>Another medicine used to treat hay fever symptoms is sodium cromoglycate, which is available as an eye drop and over-the-counter in pharmacies. </p>
<p>This medicine is known as a mast cell stabiliser. As the name suggests, it stabilises or prevents mast cells from breaking down. When mast cells break down, they release histamine and other chemicals that cause inflammation. </p>
<p>This eye drop is both a preventative and treatment medicine, usually used before allergies strike. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9375451/">Evidence shows</a> it is effective at reducing the symptoms of allergic conjunctivitis (eye inflammation from allergies). </p>
<figure class="align-center ">
<img alt="Man blows nose at pharmacy check out" src="https://images.theconversation.com/files/549220/original/file-20230920-15-ow0w0v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549220/original/file-20230920-15-ow0w0v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549220/original/file-20230920-15-ow0w0v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549220/original/file-20230920-15-ow0w0v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549220/original/file-20230920-15-ow0w0v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549220/original/file-20230920-15-ow0w0v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549220/original/file-20230920-15-ow0w0v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">If you’re not sure where to start, your pharmacist or prescriber can talk you through your options.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-pharmacist-suggesting-medical-drug-buyer-102268021">Shutterstock</a></span>
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<h2>Decongestants</h2>
<p>Decongestants constrict blood vessels. They can be taken orally, administered as a nasal spray, or instilled into the eyes. When administered into the eyes it will reduce redness, and when administered into the nose, it will stop it from running. </p>
<p>However, decongestants should be used for a short duration only and are not for long term use. In fact, if a nasal spray decongestant is used for more than five days, you can experience something called “rebound congestion”: a severe stuffy nose. </p>
<h2>Saline</h2>
<p>Saline (saltwater) nasal sprays or irrigation products are also available to flush out the allergens and provide hay fever relief. While there are not many studies in the area, there is evidence that saline irrigation <a href="https://www.cochrane.org/CD012597/ENT_nasal-saline-allergic-rhinitis#:%7E:text=Saline%20irrigation%20may%20reduce%20patient,any%20outcomes%20beyond%20three%20months">may reduce hay fever symptoms</a>. Saline is safe and is not associated with adverse effects.</p>
<p>If you’re suffering from hay fever symptoms and unsure what to try, talk to your prescriber or pharmacist, who can guide you through the options and identify the best one for your symptoms, medical conditions and medicines.</p>
<p>Allergen immunotherapy (or allergen shots) is another option hay fever sufferers <a href="https://www.allergy.org.au/patients/allergy-treatments/allergen-immunotherapy-faqs">may discuss</a> with their doctors. However it’s not a quick fix, with therapy taking three to five years.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/im-considering-allergen-immunotherapy-for-my-hay-fever-what-do-i-need-to-know-190408">I’m considering allergen immunotherapy for my hay fever. What do I need to know?</a>
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<img src="https://counter.theconversation.com/content/213071/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mary Bushell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Struggling with watery, itchy red eyes and a runny, congested nose? Here are your options for hay fever treatment.Mary Bushell, Clinical Assistant Professor in Pharmacy, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2123592023-08-29T20:13:06Z2023-08-29T20:13:06ZPharmacists should be able to work with GPs to prescribe medicines for long-term conditions<p>A national <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/unleashing-the-potential-for-our-health-workforce-review-appointment">review</a> of primary care workforce regulations is investigating ways to increase Australians’ access to quality health care.</p>
<p>The review is considering how health-care workers can use more of their skills and training, to work to their full scope of practice. This includes exploring who should be allowed to prescribe medications. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1694557062305558854"}"></div></p>
<p>Independent pharmacist prescribing is increasing around the world, and now trials are starting in most Australian states. </p>
<p>The review should focus on expanding pharmacists prescribing for stable conditions and long-term medications, under the direction of a GP.</p>
<h2>What’s the problem?</h2>
<p>It often seems like health workers are at odds, but there’s one thing the professional bodies for <a href="https://www.racp.edu.au/news-and-events/media-releases/racp-welcomes-report-from-medicare-taskforce-and-the-focus-on-multidisciplinary-care-but-patients-need-more-access-to-specialist-care">doctors</a>, <a href="https://www.apna.asn.au/about/media/budget-lays-the-groundwork-for-structural-change-in-health-care">nurses</a>, and <a href="https://ahpa.com.au/news-events/media-release-multidisciplinary-teams-the-key-to-unlocking-access-to-primary-care/">allied health workers</a> all seem to agree on: we need more team-based care. Governments agree too.</p>
<p>As rates of complex chronic disease rise, it’s no longer possible for one clinician to provide all the care, advice and support many patients need. </p>
<p>There is good <a href="https://grattan.edu.au/wp-content/uploads/2022/12/A-new-Medicare-strengthening-general-practice-Grattan-Report.pdf">evidence</a> that a team of different kinds of health professionals working together can improve access to and quality of care, and reduce costs. </p>
<p>But Australia lags other countries when it comes to letting primary care professionals use all their skills. Partly as a result, Australia ranks behind most wealthy nations in the <a href="https://pubmed.ncbi.nlm.nih.gov/36134523/">share</a> of GPs who say they delegate aspects of care to other workers. </p>
<p>That’s one reason for rushed appointments and long wait times, with nearly <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/latest-release">one-quarter</a> of Australians saying they wait too long to see a GP, and almost one-third not getting to see their preferred GP. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-you-fix-general-practice-more-gps-wont-be-enough-heres-what-to-do-195447">How do you fix general practice? More GPs won't be enough. Here's what to do</a>
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<p>There are lots of things holding teamwork back. They include workforce shortages in some parts of Australia, cultural barriers, inadequate IT systems, a fee-for-service funding model, and clinics getting too little support to change how they work. </p>
<p>But the rules about who can do what, and who gets paid for doing what, are a big part of the problem. That will be the focus of this review. </p>
<h2>Scope to share prescribing</h2>
<p>The Pharmaceutical Benefits Scheme funds <a href="https://www.pbs.gov.au/info/statistics/expenditure-prescriptions/pbs-expenditure-and-prescriptions">215 million</a> prescriptions each year. In the five years to 2021–22, that number rose by an average of 3.3 million prescriptions each year. </p>
<p>Those prescriptions can be written by authorised practitioners, such as doctors, dentists and optometrists, as well as nurse practitioners and midwife practitioners, who have post-graduate degrees. </p>
<p>Trials are underway to share this growing workload with pharmacists. This recognises pharmacists’ expertise in medicines, and their availability on a walk-in basis in most communities around Australia, including those with long waits for GP care. </p>
<p>It also reflects support from <a href="https://bpspubs.onlinelibrary.wiley.com/doi/pdf/10.1111/bcp.13624">pharmacists</a> and <a href="https://chf.org.au/sites/default/files/what_australias_health_panel_said_about_pharmacy_prescription_.pdf">patients</a> for a prescribing role. </p>
<p>Victoria’s 12-month <a href="https://www.health.vic.gov.au/primary-care/victorian-community-pharmacist-statewide-pilot">pilot</a> is set to begin in October, and will allow pharmacists to prescribe repeat scripts for oral contraceptive pills, as well as treatments for some mild skin conditions and urinary tract infections (UTIs). </p>
<p>A similar <a href="https://www.nsw.gov.au/media-releases/statewide-pharmacy-prescribing-trial-to-begin">trial</a> is under way in New South Wales. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/should-pharmacists-be-able-to-prescribe-common-medicines-like-antibiotics-for-utis-we-asked-5-experts-195277">Should pharmacists be able to prescribe common medicines like antibiotics for UTIs? We asked 5 experts</a>
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<p>Queensland, which already allows pharmacists to prescribe medications for UTIs, will begin a new <a href="https://statements.qld.gov.au/statements/96318">trial</a> later this year, allowing pharmacists to prescribe for a broader range of common health conditions. </p>
<p>Just a few weeks ago, Western Australia <a href="https://www.wa.gov.au/government/media-statements/Cook-Labor-Government/Pharmacy-option-for-UTI-diagnosis-for-Western-Australian-women-20230804">introduced</a> pharmacy prescribing for UTIs.</p>
<p>It’s new here, but in many other countries pharmacist prescribing is well established. Models vary, but pharmacists can write prescriptions in countries including Canada, New Zealand, the United States and the United Kingdom. </p>
<p>In a growing number of countries, pharmacists can prescribe independently. For example, in England <a href="https://www.england.nhs.uk/primary-care/pharmacy/pharmacy-integration-fund/independent-prescribing/">all</a> newly qualified pharmacists will soon be able to do so. </p>
<p>An approach that has been around for longer overseas but that isn’t part of trials here, is pharmacists prescribing under a clinical management plan agreed with a patient’s GP.</p>
<p>Under this model, people with stable, long-term conditions that are being successfully managed with medication can get prescriptions renewed by their pharmacist, rather than having to return to the GP. </p>
<p>The evidence shows this type of prescribing can be just as <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011227.pub2/epdf/full">effective</a> as prescribing by doctors. </p>
<h2>What approach should Australia take?</h2>
<p>The Australian review is an opportunity to follow the evidence and catch up with other countries. If expanding prescribing rights is done carefully, it will improve access to care and reduce costs, without compromising the quality and safety of care. </p>
<p>But if there are too many prescribers working independently, it could increase fragmentation of care in a system that is already disjointed and hard to navigate. This has been one <a href="https://www.racgp.org.au/gp-news/media-releases/2023-media-releases/march-2023/it-just-gets-worse-and-worse-more-concerning-detai">criticism</a> of recent Australian pharmacy prescribing trials, all of which have some component of independent prescribing. </p>
<p>By working in partnership with GPs, pharmacist prescribing could go beyond the narrow range of medicines and conditions covered in independent prescribing schemes. It would complement <a href="https://grattan.edu.au/wp-content/uploads/2018/05/208-2016-09-23-grattan-institute-submission.pdf">effective</a> pharmacy services that review medications and advise patients about them.</p>
<p>That’s why the review should focus on collaborative prescribing for stable, chronic conditions. This will help more patients, while keeping GPs at the heart of the primary care team, making sure that the pieces fit together. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-evidence-shows-pharmacist-prescribing-is-nothing-to-fear-127497">The evidence shows pharmacist prescribing is nothing to fear</a>
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</em>
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<p>As in other countries, additional training will be needed for pharmacist prescribers, and a range of implementation <a href="https://academic.oup.com/ijpp/article/27/6/479/6099842">issues</a> need to be considered. This includes ensuring:</p>
<ul>
<li>pharmacists have sufficient training and skills</li>
<li>efficient systems are in place for sharing clinical information and working with GPs</li>
<li>both the pharmacists and the GPs they work with are paid appropriately. </li>
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<p>Getting to the future of team-based care that all the major health professional groups espouse will require compromise. Pharmacy prescribing is already here, and it’s likely to go further. To get the best results for patients, community pharmacists should welcome leadership from GPs, while GPs should support pharmacist prescribing.</p><img src="https://counter.theconversation.com/content/212359/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Breadon's employer, Grattan Institute, has been supported in its work by government, corporates, and philanthropic gifts. A full list of supporting organisations is published at <a href="http://www.grattan.edu.au">www.grattan.edu.au</a>.</span></em></p><p class="fine-print"><em><span>Aaron Yin is currently on secondment to the Grattan Institute from the Victorian Department of Health.
Grattan Institute, has been supported in its work by government, corporates, and philanthropic gifts. A full list of supporting organisations is published at <a href="http://www.grattan.edu.au">www.grattan.edu.au</a>.</span></em></p>A new review of Australian health care workers’ scope of practice should focus on expanding pharmacists prescribing for stable conditions and long-term medications, under the direction of a GP.Peter Breadon, Program Director, Health and Aged Care, Grattan InstituteAaron Yin, Associate, Health & Aged Care Program, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2042302023-07-13T22:34:32Z2023-07-13T22:34:32ZFDA approves first daily over-the-counter birth control pill, Opill – a pharmacist and public health expert explain this new era in contraception<figure><img src="https://images.theconversation.com/files/537358/original/file-20230713-15-64cjm9.jpg?ixlib=rb-1.1.0&rect=49%2C35%2C4643%2C3067&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The progestin-only pill Opill could be available in early 2024.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/empty-shopping-basket-on-pharmacy-drugstore-counter-royalty-free-image/1013458454">Kwangmoozaa/iStock via Getty Images</a></span></figcaption></figure><p>On July 13, 2023, the <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive">U.S. Food and Drug Administration approved</a> a drugmaker’s application for the first daily over-the-counter birth control pill for people seeking to prevent pregnancy.</p>
<p>The pill, called Opill – the brand name for the tablet formulation of norgestrel – is an oral contraceptive containing only progestin hormone, which helps prevent pregnancy by thickening cervical mucus, preventing ovulation or both. Opill was initially approved <a href="https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/opill-0075mg-oral-norgestrel-tablet-information">by the FDA for prescription use in 1973</a>. Its approval for nonprescription use may spark other manufacturers of prescription-only birth control to follow. This highlights the importance of pharmacies as destinations for health care and pharmacists as facilitators of contraceptive care.</p>
<p>Opill is expected to be available through pharmacies, supermarkets, convenience stores and online retailers in early 2024. The FDA’s approval of an over-the-counter birth control pill can further expand options for people seeking hormonal contraception to all 50 states and U.S. territories. This expanded access could be a significant development in the post-Roe era as <a href="https://theconversation.com/one-year-after-the-fall-of-roe-v-wade-abortion-care-has-become-a-patchwork-of-confusing-state-laws-that-deepen-existing-inequalities-207390">individual states further restrict</a> women’s access to abortion. </p>
<p>Prior to the FDA’s approval of this pill, many U.S. states have allowed pharmacists to prescribe hormonal contraception. The process begins <a href="https://birthcontrolpharmacist.com/">with a pharmacist consultation</a> to screen patients for eligibility, collect a medical history and measure blood pressure. If the patient qualifies, the pharmacist can provide a prescription to the patient; if not, the pharmacist refers the patient to a physician. </p>
<p>We are a <a href="https://scholar.google.com/citations?user=9Np7_DYAAAAJ&hl=en">pharmacist</a> and a <a href="https://scholar.google.com/citations?hl=en&user=OIT2K2oAAAAJ">public health expert</a>. We see the move toward over-the-counter birth control as an important step toward accessible and equitable reproductive health care for all Americans. Even though this product will be over-the-counter, pharmacists will play an indispensable role in that effort.</p>
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<figcaption><span class="caption">The FDA’s approval of the first-ever over-the-counter daily birth control pill means that people could soon get them from the same aisles as aspirin, eye drops or condoms.</span></figcaption>
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<h2>Making birth control more accessible</h2>
<p><a href="https://doi.org/10.1016/j.japh.2022.07.003">With more than 60,000 pharmacies nationwide</a>, pharmacists are the most accessible members of the health care workforce. Nearly 90% of Americans live within <a href="https://doi.org/10.1016/j.japh.2022.07.003">5 miles of a pharmacy</a>. Throughout the COVID-19 pandemic, pharmacies have provided testing, vaccination and treatment for millions of people in the U.S., <a href="https://theconversation.com/how-the-test-to-treat-initiative-aims-to-get-ahead-of-the-next-wave-of-covid-19-179607">proving their worth</a> in supporting and sustaining initiatives that are important to public health. </p>
<p>Traditionally, hormonal contraception – also known as birth control, or when taken orally, “the pill” – has only been accessible after a comprehensive medical evaluation by a physician, physician assistant or nurse practitioner. </p>
<p>But in 2016, California and Oregon changed their legislation to allow pharmacists to prescribe birth control. That quickly expanded to 20 states, plus Washington, D.C., that now <a href="https://naspa.us/resource/contraceptives/">allow pharmacists to prescribe</a> some form of birth control, whether it be the pill, patch, ring or shot.</p>
<p>However, the move toward over-the-counter birth control is important because it will lessen some of the known barriers to birth control, especially if the products are offered at an affordable price point. These barriers include the inability to pay for medical office visits required to obtain a prescription, lack of insurance to cover the cost of prescription birth control or lack of access to pharmacist-prescribed contraception.</p>
<p>Over-the-counter birth control can also reduce access barriers by preventing the need for a scheduled appointment with a primary care physician during work hours, the need for a pharmacist to be present to dispense prescription birth control or the need to travel long distances to access these professionals. </p>
<p>But it is important to note that over-the-counter access to hormonal birth control does not replace the importance of regular office visits or discussion about reproductive health with physicians.</p>
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<figcaption><span class="caption">The use of contraception was illegal in the U.S. from the late 1800s until the 1960s.</span></figcaption>
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<h2>Addressing remaining barriers</h2>
<p>Even in states where pharmacists are currently allowed to prescribe birth control, over-the-counter hormonal birth control can make a difference.</p>
<p>For example, if state policies do not create payment pathways to reimburse pharmacists for their time to counsel and prescribe, pharmacists may choose not to participate in prescribing birth control. Additionally, pharmacist availability and time may be limited and more restricted than the hours a pharmacy is advertised as open to the public to sell over-the-counter birth control products.</p>
<p>Finally, there are notable cases of pharmacists who have denied patients access to emergency contraception, also known as the “morning-after pill,” and <a href="https://www.npr.org/2018/06/25/623307762/walgreens-pharmacist-denies-drug-for-woman-with-unviable-pregnancy">prescriptions for medication abortion</a> on the grounds of moral, ethical and religious beliefs. </p>
<p>For instance, in 2019, a pharmacist in Minnesota <a href="https://www.nbcnews.com/news/us-news/minnesota-pharmacist-trial-refusing-dispense-morning-pill-beliefs-rcna41030">denied a patient emergency contraception</a>, citing personal beliefs. As a result, the patient drove 50 miles <a href="https://www.washingtonpost.com/nation/2022/08/03/minnesota-pharmacist-contraception-lawsuit/">to gain access to the medication</a>. Ultimately, a jury found that the pharmacist did not discriminate against the woman by denying to fill her prescription.</p>
<p>This precedent suggests that pharmacists who object to the use of reproductive medications may further choose not to participate in prescribing hormonal contraception even when permitted to do so by state law. Individuals may also choose not to stock over-the-counter birth control when it becomes available.</p>
<h2>Pharmacist ‘conscience clauses’</h2>
<p>Notably, many states give pharmacists autonomy when dispensing medications. Currently, 13 states have laws or regulations known as “conscience clauses” that <a href="https://www.nbcnews.com/news/us-news/can-pharmacist-legally-deny-patient-prescription-it-depends-n894871">permit pharmacists to refuse to dispense a medication</a> when it conflicts with their religious or moral beliefs. </p>
<p>The American Pharmacists Association also recognizes an individual pharmacist’s right to conscientiously refuse to dispense a medication; however, the organization supports a system to <a href="https://aphanet.pharmacist.com/policy-manual?key=Pharmacist+Conscience+Clause&op=Search">ensure patient access to medications</a> without compromising the pharmacist’s right of refusal. In other words, pharmacists are encouraged to “step aside” but should not “step in the way” of dispensing or selling medications that conflict with their personal beliefs. </p>
<p>Some states with conscience clauses legally require pharmacists to refer patients elsewhere when they decline to dispense a medication for ethical and/or moral beliefs. In addition, company policies may require pharmacists with objections to arrange for another pharmacist – who does not have objections – to provide the medication and care requested by the patient. However, some states do not require a system to ensure this patient access as the American Pharmacists Association suggests.</p>
<p>Pharmacist conscience clauses are unlikely to interfere with over-the-counter birth control availability at large pharmacy chains, supermarkets and mass merchandisers due to top-down decision-making structures of these organizations. However, national pharmacy chains have recently faced <a href="https://www.nytimes.com/2023/03/07/business/walgreens-abortion-pill.html">complicated legal and political situations</a> when it comes to offering prescription abortion pills in the post-Roe era.</p>
<p>Ongoing <a href="https://www.guttmacher.org/state-policy">legislation seeking to reduce abortion access</a> in the post-Roe era across the U.S. only increases the importance of patient access to contraception. Geographical spatial analyses have found that people of low socioeconomic classes and of color <a href="https://read.dukeupress.edu/jhppl/article/46/2/277/166722/Affordable-but-Inaccessible-Contraception-Deserts">disproportionately reside in contraception deserts</a>, which are areas with low access to family planning resources. These contraception deserts could be reduced or eliminated altogether now that retailers may sell over-the-counter hormonal birth control at an affordable price. </p>
<h2>Pharmacists’ role in providing contraceptive</h2>
<p>Although patients may seek and purchase over-the-counter hormonal birth control at locations other than community pharmacies, when patients come to a pharmacy, pharmacists can help them understand how to use the product correctly, safely and effectively prior to purchase. Pharmacists are trained as medication experts and acquire unique knowledge and skills of self-care products and nonprescription medications. When a pharmacist feels it is necessary, they can refer patients who do not qualify for over-the-counter birth control use back to their primary care providers for further evaluation and care.</p>
<p>In our view, pharmacists can positively contribute to the safe, effective and accessible use of contraception across the country.</p>
<p><em>This is an updated version of an <a href="https://theconversation.com/with-over-the-counter-birth-control-pills-likely-to-be-approved-pharmacists-and-pharmacies-could-play-an-ever-increasing-role-in-reproductive-health-care-189216">article originally published</a> on Oct. 28, 2022.</em></p><img src="https://counter.theconversation.com/content/204230/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lucas Berenbrok is part owner of the consulting company, Embarx, LLC.</span></em></p><p class="fine-print"><em><span>Marian Jarlenski does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With the approval of the first over-the-counter oral contraceptive, pharmacists stand to play an ever-increasing role in helping expand access to reproductive health care in the post-Roe era.Lucas A. Berenbrok, Associate Professor of Pharmacy and Therapeutics, University of PittsburghMarian Jarlenski, Associate Professor of Health Policy and Management, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2055132023-05-17T13:34:07Z2023-05-17T13:34:07ZUsing pharmacists to ease pressure on GPs will only work with proper funding and more staff<figure><img src="https://images.theconversation.com/files/526748/original/file-20230517-5572-g47292.jpg?ixlib=rb-1.1.0&rect=22%2C0%2C4931%2C3297&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You may soon be able to visit your pharmacist to get certain medicines without seeing a GP first.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmacy-product-customer-pharmacist-help-man-2269716989">Yuri A/PeopleImages.com/ Shutterstock</a></span></figcaption></figure><p>The NHS is under tremendous pressure and patients are increasingly struggling to <a href="https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice-data-analysis">access appointments and urgent care</a>. In a bid to improve primary care for patients, the UK government recently outlined a <a href="https://www.england.nhs.uk/long-read/delivery-plan-for-recovering-access-to-primary-care-2/">number of changes</a> it plans to implement in England. </p>
<p>One of these proposed initiatives is allowing pharmacists to supply a number of prescription-only medicines for common conditions – including sinusitis, shingles and uncomplicated urinary tract infections – without patients needing a prescription from their GP. </p>
<p>It’s hoped that this scheme, called <a href="https://www.chemistanddruggist.co.uk/CD136989/Pharmacy-First-set-for-national-launch-by-end-of-2023-following-consultation">Pharmacy First</a>, will help save 10 million GP appointments yearly (alongside the other proposed changes) once scaled up across the country.</p>
<p>Not only are pharmacists very well-equipped in terms of knowledge and skills to provide these services, we also know from equivalent trial schemes that such programmes work well for patients. But Pharmacy First will only work if adequate funding is provided to pharmacies to ensure they can provide these additional services.</p>
<p>Pharmacists are more than capable of providing patients with good-quality care, which is why it makes sense to expand the role they have in providing patients with this care. </p>
<p>To become a pharmacist, you need to complete a four-year degree. Many of the skills learnt during study are similar to what GPs would learn – such as understanding how to make a physical assessment of a patient, in addition to the science of medicines. </p>
<p>Pharmacists must also complete a one-year work placement with a national exam at the end – after which they register with the regulator, the General Pharmaceutical Council. This means pharmacists are regulated in a similar way to doctors to ensure they practise in a safe way. </p>
<p>After graduating, pharmacists are required to complete professional development courses in order to develop specialist expertise and maintain their competence. This means pharmacists are very well-qualified to provide care to patients which complements that already provided by GPs. </p>
<figure class="align-center ">
<img alt="A young female pharmacist holding a clipboard and pen speaks with an older female customer." src="https://images.theconversation.com/files/526749/original/file-20230517-19-4mx9pf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526749/original/file-20230517-19-4mx9pf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=473&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526749/original/file-20230517-19-4mx9pf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=473&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526749/original/file-20230517-19-4mx9pf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=473&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526749/original/file-20230517-19-4mx9pf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=594&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526749/original/file-20230517-19-4mx9pf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=594&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526749/original/file-20230517-19-4mx9pf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=594&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Pharmacists are well-qualified to supply patients with certain prescription-only medicines.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmacy-medical-insurance-customer-black-woman-2269474071">Yuri A/PeopleImages.com/Shutterstock</a></span>
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<p>Furthermore, some pharmacists (mainly in hospitals and general practice) have already been able to <a href="https://www.researchgate.net/publication/5826392_Pharmacist_prescribing_in_the_UK-a_literature_review_of_current_practice_and_research">prescribe medicines to patients</a> without medical practitioner sign-off since 2006. This <a href="https://www.bmj.com/content/380/bmj-2022-071883">prescribing programme</a> has successfully shown that pharmacists are able to prescribe medicine in hospitals, care homes and GP surgeries without any compromise to patient safety. </p>
<p>In order to be able to prescribe medicines, pharmacists need to complete an accredited programme which is regulated by the General Pharmaceutical Council. This course ensures that pharmacists have the relevant diagnostic and prescribing skills to be independent prescribers, and to ensure safe prescribing for patients. </p>
<p>Prescribing skills are now being taught within the MPharm degree in the UK. This means all pharmacists joining the workforce from 2026 onwards will already be qualified to prescribe and supply prescription-only medicines. </p>
<h2>Making it work</h2>
<p>In Scotland and Wales, <a href="https://www.cps.scot/featured/nhs-pharmacy-first-scotland">similar national initiatives</a> to Pharmacy First have been in place since 2006. Based on the research we have so far from these programmes, allowing pharmacists to supply prescription-only medications has been a benefit to patients.</p>
<p>Studies have found that these initiatives are associated with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886314/">improved access to care</a> and have <a href="https://ihub.scot/media/7311/cps-mas-report-fv-jan-2019.pdf">alleviated pressures</a> in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886314/">other parts of the NHS</a>. </p>
<p>Expanding the powers of pharmacists throughout the country to supply prescription-only medicines may also be extremely beneficial to <a href="https://bmjopen.bmj.com/content/4/8/e005764">people living in deprived areas</a>, for whom pharmacies are often their only source of health advice and medicines. As such, the Pharmacy First scheme may ensure more people are able to access the healthcare they need.</p>
<p>But a major concern with the government’s plan regards the funding that will be provided. Since 2015, funding for community pharmacies has been cut by 30% in real terms, leading to the closure of <a href="https://thecca.org.uk/wp-content/uploads/2023/02/Primary-care-closures-in-England-1.pdf">720 highstreet pharmacies</a> in England. In addition, pharmacies currently rely on NHS England for <a href="https://psnc.org.uk/wp-content/uploads/2022/10/Pharmacy-Funding-and-Capacity-briefing.pdf">more than 90% of their funding</a>. </p>
<p>While community pharmacists have been calling for the Pharmacy First scheme for several years, the government’s plans will only work if there’s an immediate injection of funding. This will halt closures and alleviate the already existing pressure on community pharmacies – ensuring these additional services can readily be provided. While the government has <a href="https://www.england.nhs.uk/2023/05/patients-to-benefit-from-faster-more-convenient-care-under-major-new-gp-access-recovery-plan/">promised £645 million</a> for the Pharmacy First scheme, this will not be enough to close the funding gap that already exists while ensuring new services can be provided.</p>
<p>Pharmacists are already experiencing numerous work-related pressures. Prescription numbers <a href="https://www.ibisworld.com/uk/bed/nhs-prescriptions-volume/44123">continue to rise</a> dramatically. Paired with the fact that patients are already being encouraged to use pharmacies for <a href="https://committees.parliament.uk/writtenevidence/13438/html/">advice and treatment</a> without appointment, many pharmacists are struggling to keep up with their workload.</p>
<p>In addition, staffing levels are difficult to maintain, as pharmacists and pharmacy technicians are <a href="https://www.pulsetoday.co.uk/news/pulse-pcn/pcn-pharmacist-recruitment-has-unintended-consequences-warns-government-report">being recruited</a> to <a href="https://www.bma.org.uk/advice-and-support/gp-practices/employment-advice/employing-clinical-pharmacists-in-gp-practices">work in general practice</a>. If more isn’t done by the government to recruit pharmacists or encourage students to enrol in pharmacy courses, it may hinder the success of the Pharmacy First scheme once it’s introduced – and in the longer term, the role of community pharmacy in providing vital patient care.</p>
<p>While it’s far from certain if these plans will actually save 10 million appointments for GPs a year, it’s clear that pharmacists could be of even greater benefit to patients. But this ambitious scheme will only work if measures are taken to increase pharmacy funding and staff numbers.</p><img src="https://counter.theconversation.com/content/205513/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Portlock does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The proposed plans will likely benefit patients – but only if more is done to ensure pharmacists can provide these additional services.Jane Portlock, Professor of Pharmacy Postgraduate Education, Interim Director of CIPPET, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2011002023-04-04T14:26:08Z2023-04-04T14:26:08ZFake medicines are a dangerous threat in Africa: 3 ways to spot them<figure><img src="https://images.theconversation.com/files/519497/original/file-20230405-28-f2172w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The most common fakes tend to be the most popular medicines: painkillers, antibiotics.</span> <span class="attribution"><span class="source">Riccardo Mayer/Shutterstock</span></span></figcaption></figure><p>At the end of a long day, you realise you’re starting to get a headache. So you buy painkillers from the street vendor, and take two. But how do you know what those pills really are? The vendor isn’t a pharmacy. There’s no package insert listing ingredients or dosage instructions. What if you’ve just tried to treat your headache with counterfeit medicine?</p>
<p>The term “counterfeit medicine” refers to medicines <a href="https://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_23-en.pdf">that are</a> deliberately and fraudulently falsified or mislabelled. Also called sub-standard or falsified medicines, they would have failed to pass the quality measurements and standards which are approved by medicine regulatory authorities. They aren’t to be confused with generic medicines – those are cheaper, but still scientifically proven to be safe and efficacious versions of patented medicines. </p>
<p>The most common fakes <a href="https://www.oecd-ilibrary.org/sites/fe58fe07-en/index.html?itemId=/content/component/fe58fe07-en">tend to be</a> the most popular medicines: painkillers, antibiotics to treat infection, anti-malarials, anti-retrovirals, sexual stimulants, or weight loss medications. </p>
<p>Counterfeit medicines are a huge problem in many African countries. Research has shown that many developing countries have a high prevalence of substandard medicines. For instance, up to 88.4% of <a href="https://www.jvbd.org//article.asp?issn=0972-9062;year=2019;volume=56;issue=4;spage=288;epage=294;aulast=Arora">antimalarials</a> in some African markets have been reported as being fake. Using ineffective medicines causes <a href="https://www.who.int/publications/i/item/9789241513432">between</a> 64,000 and 158,000 deaths from malaria every year in sub-Saharan Africa.</p>
<p>Giving people medicine that won’t work or isn’t made properly is obviously dangerous. Over <a href="https://www.ajtmh.org/view/journals/tpmd/100/5/article-p1058.xml">250,000 children worldwide</a> die from these medicines each year. In the past year alone <a href="https://www.who.int/news/item/23-01-2023-who-urges-action-to-protect-children-from-contaminated-medicines">more than</a> 300 children died after ingesting counterfeit cough or pain syrups. </p>
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<a href="https://theconversation.com/cough-syrup-can-harm-children-experts-warn-of-contamination-risks-199795">Cough syrup can harm children: experts warn of contamination risks</a>
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<p>Work is underway to strengthen governments’ surveillance of counterfeit medicine. For instance, in many African countries <a href="https://gh.bmj.com/content/6/Suppl_3/e009367.full">pharmacists are being trained</a> to create awareness of such medicines and their possible infiltration into the medicine supply chain. This will make them better prepared to detect fake medicines and share information with their patients. </p>
<p>However, educating the end users of medicines – the patients – is the most important pillar of safe medicine use. Consumers must know how to visually inspect medicines for expiry dates and other identification markers. Being able to tell the difference between a good quality medicine and a fake one can make the difference between life and death. </p>
<p>As a pharmaceutical expert, I want to share my advice on three steps to take to spot a fake.</p>
<h2>Buy your medicines from legitimate places</h2>
<p>First, buy your medicines from licensed retail shops, pharmacies and dispensaries - they should display their licences on their walls. Pharmacists and their assistants are trained in the handling of medicines. They’re legally and ethically liable for the medicines under their control. This means they’ll source products through formal medicine channels which are less likely to be infiltrated by fakes. </p>
<p>Pharmaceutical personnel are also involved in their country’s pharmacovigilance system, which monitors the safety of medicines. It’s able to pick up and report serious side effects and injuries which may be caused by medicines. This system makes it possible to remove fake medicines. </p>
<p>Do not buy medicines from online pharmacies. In <a href="https://www.fip.org/file/5082">most</a> African countries, there are no legitimate online-only pharmacies. Legitimate online pharmacies should also have a physical presence in the country. <a href="https://awarerx.s3.amazonaws.com/system/redactor_assets/documents/179/NABP_Internet_Drug_Outlet_Report_Apr2013.pdf">Research</a> <a href="https://books.google.co.za/books?hl=en&lr=&id=_55UDQAAQBAJ&oi=fnd&pg=PP5&dq=he+internet+is+the+largest+source+of+counterfeit+drugs&ots=pBSol7xy3k&sig=86hJj55_c7UKc0aQuewIDW0YQyY&redir_esc=y#v=onepage&q=he%20internet%20is%20the%20largest%20source%20of%20counterfeit%20drugs&f=false">shows</a> that the internet is the largest source of counterfeit goods as most traders operate outside national borders and national laws governing the quality of medicines and their proper handling.</p>
<p>Buying medicines from unregulated markets may seem to be cheaper, but it’s extremely risky.</p>
<h2>Inspect your product</h2>
<p>Make sure to visually inspect the medicine’s external packaging.</p>
<p>It should be labelled with the product name, the details of the manufacturer – such as their name and physical address – and its expiry date. Where possible, check the batch number – this is a serial code which can be used to trace when and where the product was made. </p>
<p>If it’s a product you have used before, try to match it with previous packaging. Take a photograph of the product if you’re using it often for future comparison. </p>
<h2>Make sure the product is intact</h2>
<p>Open the package and ensure that the medication is intact. Tablets, for instance, may be blister-packed. Make sure that the blisters have not been tampered with and the seal hasn’t been broken. The blisters must all look the same and possess an expiry date and the name of the product. If the product is packaged as loose tablets or capsules in a bottle or dispenser packaging, ensure that they look uniform with no obvious discoloration, mottling (the skin of the pills looks marbled), chipping or mould. </p>
<p>Some powder residue in pills is acceptable, but there shouldn’t be too much at the bottom. This could mean the tablets are not well compressed. There should be no smell, for instance of vinegar. Capsules should be shiny and not cracked, sticky or clumped.</p>
<p>Oral liquids are more difficult to assess, but a bad odour or industrial or petrol-like smell is a sign of poor quality. The liquid should be easy to pour into a spoon and come out smoothly without clumps or solid particles. Liquids easily get contaminated with mould or bacteria so the bottle should be well sealed at the point of dispensing and when being used. Any remaining dose should be discarded within a month. Antibiotics should be discarded within seven days of opening if they have not been finished for whatever reason.</p>
<h2>When you’ve spotted a fake</h2>
<p>If you suspect that your medicine is of poor quality or fake, then you should report it to the clinic, pharmacy or national medicine regulator. Every country in Africa has a national medicine regulatory authority either as an independent agency or within the health ministry.</p><img src="https://counter.theconversation.com/content/201100/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David R. Katerere receives funding from SAMRC</span></em></p>Being able to tell the difference between good quality medicines and fakes can be a matter of life and death.David R. Katerere, Research Platform Chair for Pharmaceutical and Biotech Advancement in Africa (PBA2), Tshwane University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1989222023-03-16T12:53:05Z2023-03-16T12:53:05ZMedicine stockouts are a problem in South Africa’s clinics: how pharmacist assistants can help<figure><img src="https://images.theconversation.com/files/509704/original/file-20230213-17-vm1b6d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Tibor Duris/Shutterstock </span></span></figcaption></figure><p>Primary healthcare clinics are the main healthcare access point for <a href="https://www.gov.za/documents/national-health-act">millions</a> of South Africans.</p>
<p>There are at least <a href="https://www.idealhealthfacility.org.za/">3,467 state-funded</a> primary healthcare clinics across South Africa’s nine provinces. Most South Africans get their essential medicines from public health facilities, which serve <a href="http://www.statssa.gov.za/publications/P0318/P03182018.pdf#page=37">71%</a> of the population. </p>
<p>Nurses often run the clinics as the only available health professionals. But dispensing and medicine supply management is not their core function. When nurses have to manage essential medicine supply, it takes their attention away from quality patient care delivery. </p>
<p>This multitasking by nurses is among the <a href="https://www.researchgate.net/publication/338600763_Nurses'_Perceptions_About_Stockouts_of_Essential_Medicines_at_Primary_Health_Care_Facilities_in_Vhembe_District_South_Africa">main reasons</a> for essential medicine stockouts in the primary healthcare clinics in South Africa. </p>
<p>To improve compliance with medicine standards, the South African government started to train pharmacist assistants to increase the number of people available to help with medicine management. It recognised that producing enough fully trained pharmacists for deployment in primary healthcare clinics and would take five years or longer. </p>
<p>The training programme for post-basic pharmacist assistant qualification is two years – much shorter than that of pharmacists. There are currently <a href="https://interns.pharma.mm3.co.za/Statistics/PersonsByAssistantRoleProvince?class=btn%20btn-primary">16,250 registered</a> post-basic pharmacist assistants. </p>
<p>But many clinics still don’t have one. In my <a href="https://hsag.co.za/index.php/hsag/article/view/2041">recent research</a> I set out to assess the role of post-basic pharmacist assistants at primary healthcare clinics. The aim was to make recommendations to improve essential medicine supply management. </p>
<p>I found that around a third of the clinics we looked at didn’t have a pharmacist assistant. These clinics were more likely than other clinics to have erratic medicine supply management practices. Pharmacist assistants contribute positively in reducing essential medicine shortages. There should be urgent plans to employ more of them. </p>
<p>Essential medicines stockouts result in patients having to make multiple visits to health facilities. They spend time waiting and lose working hours. Patients are exposed to unnecessary changes in their treatment regimen as health workers try to compensate for the stockout through dose combination. </p>
<h2>Managing medicine supply</h2>
<p>My study was done in 11 of South Africa’s 52 health districts. To collect the data, I spoke to 11 district pharmaceutical service managers and reviewed medicine availability reports. </p>
<p>Only 429 (63%) of the 685 primary healthcare clinics had at least one pharmacist assistant. This means that 256 (37%) clinics did not have a pharmacist assistant to manage medicine supply. Nurses had to do the job of managing supplies of essential medicines and dispensing them. </p>
<p>I found that clinics without pharmacist assistants were more likely to have erratic medicine supply management practices. In one district without post-basic pharmacist assistants, medicine availability was an average of 88%. </p>
<p>Those with pharmacist assistants had markedly better stock levels. In 10 districts where at least a quarter of the primary healthcare clinics had post-basic pharmacist assistants, medicine availability was at an average of 95%. This figure is in line with <a href="https://www.idealhealthfacility.org.za/">acceptable norms</a>. These clinics had a lower prevalence of medicine stockouts. </p>
<p>A district pharmaceutical services manager who participated in the research said: </p>
<blockquote>
<p>We are doing well on medicine availability thanks to the availability of (pharmacist) assistants in our clinics.</p>
</blockquote>
<p>The study findings show that pharmacist assistants play a significant role in medicine supply chain management in primary healthcare clinics. Additionally, they can free up nurses to focus on providing quality healthcare services. </p>
<p>The appointment of one pharmacist assistant can free up professional nurses from managing medicine supply. It guarantees that at least <a href="https://www.sciencedirect.com/science/article/pii/S2214139122000051">40 patients</a> receive uninterrupted clinical care per day. </p>
<p>Pharmacist assistants also have the time and skill to <a href="https://pharmaceutical-journal.com/article/ld/how-pharmacists-can-encourage-patient-adherence-to-medicines">counsel patients on treatment benefits</a> and adherence. This goes a long way to encourage patients to stay on treatment.</p>
<p>Another benefit is the appropriate storage and management of essential medicines. Pharmacist assistants can ensure that medicine is kept at appropriate temperatures for effectiveness. They also implement stock rotation to use expiring medicines first. This reduces the occurrence of medicines expiring on the shelves. </p>
<p>There have been initiatives within government to encourage the permanent appointment of trained pharmacist assistants in primary healthcare clinics. However, many provincial clinics struggle to permanently appoint at least one pharmacist assistant due to financial constraints. In some instances, donors have stepped in to finance short-term contracts for pharmacist assistants as a temporary solution.</p>
<p>The lack of effective placements has also meant that the private health sector has absorbed many government-trained pharmacist assistants. The <a href="https://interns.pharma.mm3.co.za/Statistics/PharmaciesBySector?class=btn%20btn-primary">majority</a> of pharmacists (and pharmacist assistants) in South Africa practise in community pharmacies, which are pharmacist-owned (independent) or form part of pharmacy chains.</p>
<h2>Recommendations</h2>
<p>To promote consistent essential medicine availability, National Treasury needs to allocate dedicated funding for the permanent employment of at least one post-basic pharmacist assistant in each of the primary healthcare clinics across South Africa.</p>
<p>Provincial district health services must phase in the permanent employment of post-basic pharmacist assistants. This will go a long way in promoting good medicine supply management at clinics.</p><img src="https://counter.theconversation.com/content/198922/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sibusiso Zuma works for University of South Africa. He received funding from Africa Resource Centre. </span></em></p>Clinics without pharmacist assistants were more likely to have erratic medicine supply management practices.Sibusiso Zuma, Researcher, University of South AfricaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1952772022-11-25T00:56:41Z2022-11-25T00:56:41ZShould pharmacists be able to prescribe common medicines like antibiotics for UTIs? We asked 5 experts<figure><img src="https://images.theconversation.com/files/497114/original/file-20221123-26-2pn0oa.jpg?ixlib=rb-1.1.0&rect=76%2C0%2C5035%2C2835&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/covid19-pharmacy-wearing-face-masks-professional-1999646480">Shutterstock</a></span></figcaption></figure><p>Victoria is the latest state to move towards pharmacist prescribing, with Premier Daniel Andrews <a href="https://www.aap.com.au/news/andrews-scores-narrow-vic-poll-debate-win/">promising a trial</a> allowing pharmacists to prescribe antibiotics for urinary tract infections (UTIs) and medicines for other conditions if re-elected. </p>
<p>UTIs are <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/urinary-tract-infections-uti">common</a>, especially among women, with half getting at least one in their lifetime. </p>
<p>Last week the New South Wales government <a href="https://www.nsw.gov.au/media-releases/pharmacy-reform">announced</a> a trial allowing pharmacists to give a range of travel vaccinations and prescribe antibiotics for UTIs. And on Tuesday, the Northern Territory <a href="https://www1.racgp.org.au/newsgp/professional/mixed-response-to-state-s-gp-workforce-solutions">passed legislation</a> to expand the role of pharmacists. </p>
<p><a href="https://statements.qld.gov.au/statements/95679">Queensland</a> was the first state to expand this scope of practice – pharmacists can prescribe medicines for UTIs, after a two-year trial. The state is now trialling a <a href="https://www.health.qld.gov.au/__data/assets/pdf_file/0028/1178434/FAQs.pdf">pilot program</a> allowing pharmacists to prescribe for a range of other common conditions. </p>
<p>Proponents of pharmacist prescribing argue it expands health-care options for people who can’t access a GP and highlights pharmacists’ expertise with medicines. Meanwhile, those opposed raise concerns about safety and antibiotic resistance. </p>
<p>So should pharmacists be able to prescribe common medicines such as antibiotics for UTIs? We asked 5 experts. </p>
<h2>Three out of five said yes</h2>
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<img alt="" src="https://images.theconversation.com/files/497302/original/file-20221125-13-wao8vv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/497302/original/file-20221125-13-wao8vv.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=99&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497302/original/file-20221125-13-wao8vv.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=99&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497302/original/file-20221125-13-wao8vv.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=99&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497302/original/file-20221125-13-wao8vv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=125&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497302/original/file-20221125-13-wao8vv.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=125&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497302/original/file-20221125-13-wao8vv.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=125&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><strong><em>Here are their detailed responses:</em></strong></p>
<p><iframe id="tc-infographic-794" class="tc-infographic" height="300" src="https://cdn.theconversation.com/infographics/794/50d11928774747fa649dd4954bbfe98071ed3da1/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
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<img alt="" src="https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>Disclosure statements: <strong>Brett Mitchell</strong> receives funding from the National Health and Medical Research Council. He has received research funding from the NHMRC, HCF Foundation, Medtronics, Australasian College for Infection Prevention and Control, Nurses Memorial Centre, Senver, GAMA Healthcare, Ian Potter Foundation and Commonwealth (Innovation Connections grant). He is Editor-in-Chief of Infection, Disease and Health; <strong>Henry Cutler</strong> receives funding from the Australian Healthcare and Hospitals Association; <strong>Jaya Dantas</strong> receives funding from Healthway, Lotterywest, & DISER. She is International Health SIG Convenor of the Public Health Association of Australia, a member of the Global Gender Equality in Health Leadership Committee, Women in Global Health, Australia and the President of Australian Graduate Women; <strong>Lisa Nissen</strong> received funding from Queensland Department of Health to evaluate the implementation of the recent Queensland Urinary Tract Pharmacy Pilot in her previous role at Queensland University of Technology. She is a past president of the Pharmaceutical Society of Australia (Queensland) and past Chairman of the Society of Hospital Pharmacists of Australia (Queensland); <strong>Louise Stone</strong> is member of the RACGP, ACRRM and ASPM.</em></p><img src="https://counter.theconversation.com/content/195277/count.gif" alt="The Conversation" width="1" height="1" />
Three out of five said yes.Fron Jackson-Webb, Deputy Editor and Senior Health EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1921622022-11-14T01:52:17Z2022-11-14T01:52:17ZPharmacists could help curb the mental health crisis – but they need more training<figure><img src="https://images.theconversation.com/files/494050/original/file-20221108-16-f7uebu.jpg?ixlib=rb-1.1.0&rect=18%2C18%2C6164%2C4097&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://theconversation.com/drafts/192162/edit">Shutterstock</a></span></figcaption></figure><p>Chances are you live within 2.5 kilometres of a community pharmacy and visit one about every <a href="https://www.guild.org.au/__data/assets/pdf_file/0020/12908/Vital-facts-on-community-pharmacy.pdf">three weeks</a>. </p>
<p>You don’t need an appointment. The wait time is usually short. These factors make <a href="https://pubmed.ncbi.nlm.nih.gov/33867054/">pharmacists highly accessible</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755826/">healthcare professionals</a>. </p>
<p>Pharmacists are regularly sought after for advice, including about mental health. In fact, pharmacists may be among the <a href="https://mhaustralia.org/general/pharmacists-role-mental-health">first</a> health professional contacted about a <a href="https://pubmed.ncbi.nlm.nih.gov/20225134/">health concern</a>. They are also in <a href="https://pubmed.ncbi.nlm.nih.gov/30070236/">regular contact</a> with patients experiencing mental health issues or crises.</p>
<p>Despite the fact most pharmacists believe it is part of their role to <a href="https://pubmed.ncbi.nlm.nih.gov/30070236/">provide mental health-related help</a>, they may <a href="https://pubmed.ncbi.nlm.nih.gov/34560826/">lack the confidence</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/30070236/">respond to, raise or manage</a> mental health issues with patients. In our recent study, pharmacists report not intervening about <a href="https://onlinelibrary.wiley.com/doi/10.1111/eip.13361">25% of the time</a> when they believe a patient is experiencing a problem or crisis. </p>
<p>Providing pharmacists with early intervention skills could help them address these challenges. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pixels-are-not-people-mental-health-apps-are-increasingly-popular-but-human-connection-is-still-key-192247">Pixels are not people: mental health apps are increasingly popular but human connection is still key</a>
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<h2>The pandemic has seen mental health decline</h2>
<p>The COVID pandemic has seen anxiety and depression <a href="https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide">increase by 25%</a> globally, signalling a broader mental health decline. </p>
<p>Poor mental health affects around 20% of the <a href="https://www.abs.gov.au/statistics/health/mental-health/national-study-mental-health-and-wellbeing/latest-release">Australian population</a> each year, and <a href="https://www.abs.gov.au/media-centre/media-releases/study-paints-picture-mental-disorders-australia">44% of Australians</a> over their lifetime. In a <a href="https://psychology.org.au/about-us/news-and-media/media-releases/2022/bleak-new-figures-confirm-depth-of-mental-health-c">recent survey</a> of 11,000 people, 24% of them said their mental health had declined over the previous six months. </p>
<p>Most concerning is that about 60% of people experiencing a mental health issue <a href="https://www.blackdoginstitute.org.au/about/who-we-are/#:%7E:text=And%20roughly%2060%25%20of%20these,this%20through%20'translational'%20research.">won’t seek help</a>. This means people are more likely to remain undiagnosed and disconnected from support. </p>
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<h2>Pharmacists’ many hats</h2>
<p>While dispensing and consulting are critical activities for pharmacists, they also help patients with questions and advice about their health, including their mental health.</p>
<p>Generally, <a href="https://pubmed.ncbi.nlm.nih.gov/21070104/">pharmacists in Australia</a> have high levels of mental health-related literacy and <a href="https://pubmed.ncbi.nlm.nih.gov/33867054/">evidence-based treatments</a>.</p>
<p>Despite this, pharmacists report a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9098086/">lack of confidence</a> which <a href="https://pubmed.ncbi.nlm.nih.gov/28153705/">prevents them</a> from raising mental health issues with patients. This is possibly because only 29% of pharmacists in Australia have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350138/">mental health crisis training</a>.</p>
<p>A lack of confidence in raising and addressing mental health-related issues means patients are likely to remain undiagnosed, untreated, and unsupported.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/scared-of-needles-claustrophobic-one-longer-session-of-exposure-therapy-could-help-as-much-as-several-short-ones-193525">Scared of needles? Claustrophobic? One longer session of exposure therapy could help as much as several short ones</a>
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</em>
</p>
<hr>
<h2>4 key elements of mental health first aid</h2>
<p>Many of us are familiar with first aid as immediate help offered to an injured or sick person. But what if the issue is not physical, but mental? Many people don’t know what immediate help they can offer. </p>
<p>As with physical injury or illness, timely and high-quality immediate help is critical. </p>
<p>There are a variety of not-for-profit and commercial mental health first aid training programs. A recent literature review of programs for mental health professionals suggests they can <a href="https://pubmed.ncbi.nlm.nih.gov/35500153/">minimise stigma</a> and <a href="https://www.tandfonline.com/doi/full/10.3109/09540261.2014.924910">increase knowledge</a>. They can also bolster <a href="https://www.sciencedirect.com/science/article/pii/S1551741122001991">confidence</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/29851974/">intentions to help</a>. </p>
<p>Across the programs, there are four common elements to providing high-quality mental health first aid.</p>
<p><strong>1. Recognise someone may be experiencing a mental health issue or crisis</strong></p>
<p>Recognising a mental health issue or crisis involves taking notice of verbal, physical, emotional and behavioural indicators. Given pharmacists interact with patients about every three weeks, they may be in a good position to notice changes. </p>
<p>They may express sadness, anger, frustration, hopelessness, shame or guilt. Patients might say: “There’s no hope” or “I can’t go on like this”.</p>
<p>Physical indicators include fatigue, sleeping difficulties, restlessness, muscle tension, upset stomach, sweating, difficulty breathing, changes in appetite or weight. </p>
<p>Emotional indicators reflect how a person is feeling and include significant mood changes, teariness, agitation, anger, desperation or anxiety. </p>
<p><a href="https://www.blackdoginstitute.org.au/resources-support/fact-sheets/">Symptom guides</a> for anxiety, depression, bipolar disorder, and suicidal ideation are available. </p>
<p><strong>2. Approach and assesses the person</strong></p>
<p>Opening the dialogue can be as simple as, “How are you? I have noticed [symptoms] and am concerned.” </p>
<p>Your role is not to clinically diagnose a patient; however, it is valuable to assess the patient’s risk and level of urgency. Risk and urgency will help inform whether the person is in immediate danger or can use other non-urgent support services. </p>
<p>The TED acronym can guide first discussions in the following way: </p>
<blockquote>
<p>Tell me … </p>
<p>Explain how that has been impacting you … </p>
<p>Describe what is happening … </p>
</blockquote>
<p><strong>3. Listen in an active way and communicate without judgement</strong> </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1636963/">Active listening</a> involves confirming you are hearing and understanding the other person. <a href="https://www.ucsfhealth.org/education/active-listening-strategies">Ways of doing this include</a>: nodding, appropriate eye contact, and summarising what has been shared. </p>
<p>Communicating without judgement involves demonstrating genuine concern for the other person and talking about their experience. </p>
<p>Open-ended questions usually use “how” and “what” queries. You could say something like: “I’ve noticed some changes recently, what’s happening for you?” or “I see you are filling a prescription for sleep tablets. How are you sleeping?” </p>
<p><strong>4. Refer the person to supports</strong></p>
<p>People who are struggling with their mental health can benefit from sharing details with professionals, like general practitioners, or family and friends – but they might need encouragement to seek this support out.</p>
<p>The support system recommended should match the level of urgency. Urgent services include Lifeline for free 24-hour <a href="https://www.lifeline.org.au/">phone, chat, and text message</a> support. The <a href="https://www.suicidecallbackservice.org.au/">Suicide Call Back Service</a> is also a free 24/7 counselling service. </p>
<p>If in doubt or in an emergency, dial 000. </p>
<p>Non-urgent and free online support is available from <a href="https://www.headtohealth.gov.au/">Head to Health</a>, the <a href="https://www.blackdoginstitute.org.au/">Black Dog Institute</a> and <a href="https://www.beyondblue.org.au/">Beyond Blue</a>. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-look-after-your-mental-health-if-youre-at-home-with-covid-174536">How to look after your mental health if you're at home with COVID</a>
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</em>
</p>
<hr>
<h2>Could training community pharmacists help?</h2>
<p>Studies in <a href="https://pubmed.ncbi.nlm.nih.gov/30070236/">Australia</a>, <a href="https://www.sciencedirect.com/science/article/pii/S155174112200002X">New Zealand</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350138/">Canada</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/32580909/">abroad</a> all point to pharmacists’ believing <a href="https://pubmed.ncbi.nlm.nih.gov/30070236/">they need more training</a> in mental health first aid. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/32139284/">Research</a> suggests almost 70% of patients believe all pharmacists should have mental health first aid training. Patients report feeling significantly more comfortable speaking about mental illness with a pharmacist with this training. </p>
<p>And emerging evidence shows mental health first aid training can increase the <a href="https://ijmhs.biomedcentral.com/articles/10.1186/1752-4458-8-46">quality</a> of help provided by pharmacists. </p>
<p>In our <a href="https://onlinelibrary.wiley.com/doi/10.1111/eip.13361">study</a>, we found Australian pharmacists with mental health first aid training were more likely to intervene than untrained pharmacists. </p>
<p>While the overall quality of the first aid provided by both mental health first aid trained and untrained pharmacists was high, some key differences existed. Trained pharmacists assessed patients and encouraged other supports (such as from friends and family) more. They also felt more confident discussing suicide risk. </p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/192162/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Carpini collaborates with Mental Health First Aid (MHFA) Australia on research projects. Specifically, MHFA Australia has assisted in the dissemination of surveys and recruitment of participants for other research studies that do not overlap with findings related to pharmacists. MHFA Australia was not involved in the research examining pharmacists in any way. Joseph does not receive compensation, directly or indirectly, from MHFA Australia. He has completed Mental Health First Aid training. </span></em></p><p class="fine-print"><em><span>Deena Ashoorian collaborates with Mental Health First Aid Australia on research projects. In addition to being a pharmacist, Deena is an accredited Master Instructor of the Mental Health First Aid program.</span></em></p><p class="fine-print"><em><span>Rhonda Clifford collaborates with students and colleagues to deliver MHFA research projects and other projects related to Mental Health.</span></em></p>Pharmacists develop basic mental health knowledge as part of their formal training. But they report a lack the confidence about raising mental health issues with patients.Joseph A Carpini, Lecturer, Organizational Behaviour and Human Resource Management, The University of Western AustraliaDeena Ashoorian, Senior Lecturer, Pharmacy Discipline, The University of Western AustraliaRhonda Clifford, Professor, Allied Health, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1892162022-10-28T12:32:36Z2022-10-28T12:32:36ZWith over-the-counter birth control pills likely to be approved, pharmacists and pharmacies could play an ever-increasing role in reproductive health care<figure><img src="https://images.theconversation.com/files/487887/original/file-20221003-22-rx39dq.jpg?ixlib=rb-1.1.0&rect=395%2C0%2C5595%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The over-the-counter birth control pill will not require medical examinations or prescriptions prior to purchase.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cheerful-woman-in-modern-pharmacy-royalty-free-image/1360043428?phrase=pharmacy&adppopup=true">Sergey Mironov/Moment via Getty Images</a></span></figcaption></figure><p>The U.S. Food and Drug Administration is <a href="https://www.reuters.com/legal/us-fda-review-perrigos-birth-control-pill-otc-use-november-2022-09-12/">set to review</a> a drugmaker’s application for the <a href="https://www.statnews.com/2022/07/11/drugmaker-seeks-fda-approval-of-over-the-counter-birth-control-pill/">first over-the-counter birth control pill</a> in November 2022, with a decision expected in the first half of 2023. </p>
<p>An approved over-the-counter hormonal birth control product would not require a prescription and <a href="https://www.selfcarefederation.org/what-is-self-care">would be considered self-care</a>, defined as “the practice of individuals looking after their own health using the knowledge and information available to them.” </p>
<p>Currently, in many U.S. states, pharmacists can already prescribe hormonal contraception that requires a prescription. The process begins <a href="https://birthcontrolpharmacist.com/">with a pharmacist consultation</a> to screen patients for eligibility, collect a medical history and measure blood pressure. If the patient qualifies, the pharmacist can provide a prescription to the patient; if not, the pharmacist refers the patient to a physician. </p>
<p>The FDA’s approval of an over-the-counter birth control pill will further expand options for people seeking hormonal contraception to all 50 states. The first such over-the-counter pill – <a href="https://www.reuters.com/legal/us-fda-review-perrigos-birth-control-pill-otc-use-november-2022-09-12/">a non-estrogen, progestin-only contraceptive</a> – could become available by mid-2023. </p>
<p>We are a <a href="https://scholar.google.com/citations?user=9Np7_DYAAAAJ&hl=en">pharmacist</a> and a <a href="https://scholar.google.com/citations?hl=en&user=OIT2K2oAAAAJ">public health expert</a>. We see the move toward over-the-counter birth control as an important step toward accessible and equitable reproductive health care for all Americans, and pharmacists will play an indispensable role in that effort.</p>
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<figcaption><span class="caption">The FDA will consider the application from HRA Pharma in November 2022.</span></figcaption>
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<h2>Making birth control more accessible</h2>
<p><a href="https://doi.org/10.1016/j.japh.2022.07.003">With more than 60,000 pharmacies nationwide</a>, pharmacists are the most accessible members of the health care workforce. Nearly 90% of Americans live within <a href="https://doi.org/10.1016/j.japh.2022.07.003">5 miles of a pharmacy</a>. Throughout the COVID-19 pandemic, pharmacies provided testing, vaccination and treatment for millions of people in the U.S., proving their worth in supporting and sustaining initiatives that are important to public health.</p>
<p>Traditionally, hormonal contraception – also known as birth control, or when taken orally, “the pill” – has only been accessible after a comprehensive medical evaluation by a physician, physician assistant or nurse practitioner. </p>
<p>But in 2016, California and Oregon became the first states to allow pharmacists to prescribe birth control. That quickly expanded to 20 states plus Washington, D.C. that now <a href="https://naspa.us/resource/contraceptives/">allow pharmacists to prescribe</a> some form of birth control, whether it be the pill, patch, ring or shot.</p>
<p>However, the move toward nonprescription-based, over-the-counter birth control is important because it will greatly lessen some of the known barriers to birth control. These barriers include the inability to pay for medical office visits required to obtain a prescription, lack of insurance to cover the cost of prescription birth control or lack of accessibility to pharmacist-prescribed contraception.</p>
<p>Over-the-counter birth control can also reduce access barriers by preventing the need for a scheduled appointment with a primary care physician during work hours or the need to travel long distances to get such care.</p>
<p>But it is important to note that over-the-counter access to hormonal birth control does not replace the importance of regular office visits or discussion about reproductive health with physicians.</p>
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<figcaption><span class="caption">The use of contraception was illegal in the U.S. from the late 1800s until the 1960s.</span></figcaption>
</figure>
<h2>Addressing remaining barriers</h2>
<p>Even in states where pharmacists are currently allowed to prescribe birth control, patients may still face barriers. </p>
<p>For example, if state policies do not create payment pathways to reimburse pharmacists for their time to counsel and prescribe, pharmacists may choose not to participate. Additionally, pharmacist availability and time may be limited and more restricted than the hours a pharmacy is advertised as open.</p>
<p>Finally, there are notable cases of pharmacists who have denied patients access to emergency contraception, also known as the “morning-after pill,” and <a href="https://www.npr.org/2018/06/25/623307762/walgreens-pharmacist-denies-drug-for-woman-with-unviable-pregnancy">prescriptions for medication abortion</a> on the grounds of moral, ethical and religious beliefs. </p>
<p>For instance, in 2019, a pharmacist in Minnesota <a href="https://www.nbcnews.com/news/us-news/minnesota-pharmacist-trial-refusing-dispense-morning-pill-beliefs-rcna41030">denied a patient emergency contraception</a>, citing personal beliefs. As a result, the patient drove 50 miles <a href="https://www.washingtonpost.com/nation/2022/08/03/minnesota-pharmacist-contraception-lawsuit/">to gain access to the medication</a>. Ultimately, a jury found that the pharmacist did not discriminate against the woman by denying to fill her prescription.</p>
<p>This precedent suggests that pharmacists who object to the use of reproductive medications may further choose not to participate in prescribing hormonal contraception even when permitted to do so by state law. They may also choose not to sell over-the-counter birth control when it becomes available.</p>
<h2>Pharmacist ‘conscience clauses’</h2>
<p>Notably, many states give pharmacists autonomy when dispensing medications. Currently, 13 states have laws or regulations known as “conscience clauses” that <a href="https://www.nbcnews.com/news/us-news/can-pharmacist-legally-deny-patient-prescription-it-depends-n894871">permit pharmacists to refuse to dispense a medication</a> when it conflicts with their religious or moral beliefs. </p>
<p>The American Pharmacists Association also recognizes an individual pharmacist’s right to conscientiously refuse to dispense a medication; however, the organization supports a system to <a href="https://aphanet.pharmacist.com/policy-manual?key=Pharmacist+Conscience+Clause&op=Search">ensure patient access to medications</a> without compromising the pharmacist’s right of refusal. In other words, pharmacists are encouraged to “step aside” but should not “step in the way” of dispensing or selling medications that conflict with their personal beliefs. </p>
<p>Some states with conscience clauses legally require pharmacists to refer patients elsewhere when they decline to dispense a medication for ethical and/or moral beliefs. In addition, company policies may require pharmacists with objections to arrange for another pharmacist – who does not have objections – to provide the medication and care requested by the patient. However, some states do not require a system to ensure this patient access as the American Pharmacists Association suggests.</p>
<h2>Contraception deserts</h2>
<p>Ongoing <a href="https://www.guttmacher.org/state-policy">legislation seeking to reduce abortion access</a> in the post-Roe era across the U.S. only increases the importance of patient access to contraception. Geographical spatial analyses have found that people of low socioeconomic classes and of color <a href="https://read.dukeupress.edu/jhppl/article/46/2/277/166722/Affordable-but-Inaccessible-Contraception-Deserts">disproportionately reside in contraception deserts</a>, which are areas with low access to family planning resources. These contraception deserts could be reduced or eliminated altogether in states that authorize pharmacists to prescribe contraception, or in areas with access to community pharmacies carrying hormonal birth control when available.</p>
<p>In our view, pharmacists can positively contribute to the safe, effective and accessible use of contraception across the country.</p><img src="https://counter.theconversation.com/content/189216/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Some states already allow pharmacists to provide birth control to patients with a prescription. But FDA approval of an over-the-counter birth control pill could greatly expand access.Lucas A. Berenbrok, Associate Professor of Pharmacy and Therapeutics, University of PittsburghMarian Jarlenski, Associate Professor of Health Policy and Management, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1889842022-08-28T20:04:58Z2022-08-28T20:04:58ZThe physio will see you now. Why health workers need to broaden their roles to fix the workforce crisis<figure><img src="https://images.theconversation.com/files/481019/original/file-20220825-16-wo9502.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1917%2C1077&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/qvFlxrDSyXU">Andrik Langfield/Unsplash</a></span></figcaption></figure><p><em>This article is part of The Conversation’s series looking at Labor’s jobs summit. Read the other articles in the series <a href="https://theconversation.com/au/topics/jobssummit2022-125921">here</a>.</em></p>
<hr>
<p>The greatest workforce challenge Australia faces is in health, an issue that will likely be with us for another decade.</p>
<p>Shortages of health workers reduce access to care, increase waiting times and reduce patient safety. They can even <a href="https://qualitysafety.bmj.com/content/28/8/609">increase avoidable deaths</a>.</p>
<p>However, we don’t need the upcoming <a href="https://treasury.gov.au/employment-whitepaper/jobs-summit">Jobs and Skills Summit</a> to solve this problem. There is already low-hanging fruit to pick.</p>
<p>We need to broaden the scope of practice for some health workers, engage in better workforce planning, and reform how existing and new resources are deployed.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/general-practices-are-struggling-here-are-5-lessons-from-overseas-to-reform-the-funding-system-188902">General practices are struggling. Here are 5 lessons from overseas to reform the funding system</a>
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<h2>Health workers burnt out and leaving</h2>
<p><a href="https://grattan.edu.au/news/how-to-tackle-burnout-among-healthcare-workers">Burnt-out health workers</a> leaving the workforce are a key driver of a rise in <a href="https://www.seek.com.au/employer/market-insights/healthcare-pulse-report">job vacancies</a> across Australia.</p>
<p>While much of this is due to the unprecedented nature of COVID, Australia has had problems staffing its health-care system <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/BriefingBook46p/HealthWorkforce">for years</a>. The workforce shortage is particularly acute in rural and remote regions. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1521974048825438208"}"></div></p>
<p>The natural response is to throw money at the problem but the Australian government has little spare cash. Its budget deficit is projected to be more than <a href="https://budget.gov.au/2022-23/content/bp1/download/bp1_2022-23.pdf">A$800 billion</a> by 2025-26. State governments are also cash-strapped.</p>
<p>More immigration of skilled health workers may also have limited success. Australia will be competing with countries including New Zealand, Canada, the United States and the United Kingdom, which are looking to fill their own health worker <a href="https://www.health.org.uk/publications/nhs-workforce-projections-2022#:%7E:text=Workforce%20shortages%20were%20the%20single,on%20staff%20wellbeing%20and%20absence">shortages</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/despite-what-political-leaders-say-new-zealands-health-workforce-is-in-crisis-but-its-the-same-everywhere-else-187256">Despite what political leaders say, New Zealand's health workforce is in crisis – but it's the same everywhere else</a>
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</em>
</p>
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<h2>Health workers could take on more roles</h2>
<p>Health worker registration, along with standards and protocols, are essential for ensuring safe and effective care. However, this also stops health workers taking on new roles typically performed by others.</p>
<p>The potential for broadening health workers’ roles has been discussed for <a href="https://www.pc.gov.au/inquiries/completed/health-workforce/report/healthworkforce.pdf">more than two decades</a>. There has been some progress. Pharmacists now administer some vaccines, which was traditionally the domain of GPs and nurses.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/480698/original/file-20220824-25-n9cfmt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pharmacist giving vaccine in upper arm of seated female customer" src="https://images.theconversation.com/files/480698/original/file-20220824-25-n9cfmt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/480698/original/file-20220824-25-n9cfmt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/480698/original/file-20220824-25-n9cfmt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/480698/original/file-20220824-25-n9cfmt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/480698/original/file-20220824-25-n9cfmt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/480698/original/file-20220824-25-n9cfmt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/480698/original/file-20220824-25-n9cfmt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Pharmacists now give some vaccines, once the domain of GPs and nurses.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/paris-france-december-20-2021-vaccination-2097845026">Victor Joly/Shutterstock</a></span>
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<p>A broader scope of practice for some health workers <a href="https://www.pc.gov.au/research/completed/efficiency-health/efficiency-health.pdf">can increase</a> people’s access to care, create more job satisfaction for the health worker, and lead to more efficient health care. It could also help the health-care system respond better and quicker to future pandemics or large-scale reform.</p>
<p>Overall, peak organisations and specialist colleges have effectively protected their turf. This may have resulted in <a href="https://www.pc.gov.au/research/completed/efficiency-health/efficiency-health.pdf">more expensive care</a> for the public and the government because it has stopped less-costly health workers from delivering care.</p>
<p>We are now faced with a more serious problem. A broader scope of practice for some health workers is needed to secure <em>timely</em> access to care. That stronger message will help government bash through future turf wars.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-rivalries-between-doctors-and-pharmacists-turned-into-the-turf-war-we-see-today-122534">How rivalries between doctors and pharmacists turned into the 'turf war' we see today</a>
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</em>
</p>
<hr>
<h2>New roles for paramedics, pharmacists, physios</h2>
<p>Health workers in other countries are becoming more flexible in the scope of tasks they perform.</p>
<p>The UK’s National Health Service <a href="https://www.nuffieldtrust.org.uk/files/2017-01/reshaping-the-workforce-web-final.pdf">has</a> “extended roles”, such as nurses being more involved in managing chronic diseases. There are also “advanced roles”, which require a master’s degree in advanced practice. One example is allowing advanced nurse practitioners to manage people with mental health issues in the community, under the guidance of a psychiatrist. </p>
<p>Australia is also starting to think differently. The ten-year <a href="https://www.health.gov.au/sites/default/files/documents/2022/03/national-medical-workforce-strategy-2021-2031.pdf">National Medical Workforce Strategy</a> released in 2021 seeks to re-balance from sub-specialisation to a more generalist workforce to improve access to care. The hope is to create more GPs and specialists with additional skills, such as emergency care, and other select specialist skills.</p>
<p>There are opportunities to expand the roles of paramedics, especially in rural and remote regions without enough GPs and nurses. </p>
<p>Paramedics <a href="https://bmcmedicine.biomedcentral.com/track/pdf/10.1186/s12916-021-02019-z.pdf">have evolved</a> from delivering emergency care to managing chronic disease, mental health and social care. Additional paramedic education to understand diagnostic tests, prescribe some medicines and deliver wound care could increase patients’ access to health care.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1561006398674276354"}"></div></p>
<p>Physiotherapists could be the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478452/">first point of contact</a> for musculoskeletal conditions. They could give steroid injections and refer patients to orthopaedic specialists.</p>
<p>Pharmacists could also take a greater role, administering medicines over the counter rather than requiring a prescription from GPs. </p>
<p>Sexual health is one area. Allowing women to access the oral contraceptive pill without a prescription would be <a href="https://pubmed.ncbi.nlm.nih.gov/31069781/">cost effective</a> with minimal risk. Viagra requires a prescription in Australia but is sold over the counter <a href="https://www.bbc.com/news/health-42155489">in the UK</a>.</p>
<h2>How do we fund this?</h2>
<p>Any health workforce reform to address shortages must ensure quality and safety are maintained and provide at least as good an experience to patients compared to current practice.</p>
<p>It must also be accompanied by supportive funding models. </p>
<p>Nurse practitioners provide a good example. They were <a href="https://www.researchgate.net/publication/291764586_A_Historical_Review_of_the_Nurse_Practitioner_Role_in_Australia/link/5eaa049345851592d6abaf98/download">introduced in Australia in 1998</a> to fill doctor shortages, allowing registered nurses with additional education to diagnose, perform procedures and prescribe drugs – within tightly defined parameters.</p>
<p>Today, <a href="https://consultations.health.gov.au/health-workforce/nurse-practitioner-10-year-plan-survey/supporting_documents/Nurse%20Practitioner%2010%20Year%20Plan%20Consultation%20Paper.pdf">most</a> nurse practitioners work in public health, particularly emergency departments.</p>
<p>More nurse practitioners aren’t in private practice for a number of reasons, including <a href="https://consultations.health.gov.au/++preview++/health-workforce/nurse-practitioner-10-year-plan-survey/supporting_documents/Nurse%20Practitioner%2010%20Year%20Plan%20Consultation%20Paper.pdf">restricted access</a> to Medicare and pharmaceutical item numbers.</p>
<p>With appropriate funding models, expanding nurse practitioner roles could substantially increase access to care and <a href="https://www.health.gov.au/sites/default/files/documents/2021/03/cost-benefit-analysis-of-nurse-practitioner-models-of-care.pdf">reduce health-care costs</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-could-do-so-much-more-with-its-nurse-practitioners-17693">Australia could do so much more with its nurse practitioners</a>
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</em>
</p>
<hr>
<h2>We need better planning</h2>
<p>Health workforce shortages are an endemic, multifaceted, cross-jurisdictional problem. COVID has amplified shortages, but poor planning and limited government investment are mostly to blame.</p>
<p>There is an under-supply of specialists in some areas, and oversupply of specialists in others. <a href="https://www.health.gov.au/resources/publications/national-medical-workforce-strategy-2021-2031">Redistributing</a> the health workforce, from metropolitan regions to rural and remote regions, would fill some shortages. </p>
<p>Australia also needs another independent agency such as Health Workforce Australia. This was <a href="https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/bd/bd1314a/14bd077">established</a> to support workforce reform initiatives in 2009 but abolished in 2014. </p>
<p>Roles of a new agency should include independently identifying workforce needs across the health-care system, helping coordinate investment in education and training, and providing evidence for broadening workforce scope, retention and reform. </p>
<h2>What policies would we need?</h2>
<p>The health-care system must also reform to reduce waste and redeploy valuable resources more effectively. </p>
<p><a href="https://www.oecd.org/health/health-systems/Empowering-Health-Workforce-Digital-Revolution.pdf">Digital health</a> and other technology advancements offer opportunities to improve workplace productivity, alongside reorganisation of care models. </p>
<p>Reducing bureaucracy and better allocating administration tasks to non-clinical staff can also create more time for clinical care.</p><img src="https://counter.theconversation.com/content/188984/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Henry Cutler does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The greatest workforce challenge Australia faces is in health, an issue that will likely be with us for another decade. Here’s one way to fix it.Henry Cutler, Professor and Director, Macquarie University Centre for the Health Economy, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1848902022-08-23T12:24:28Z2022-08-23T12:24:28ZOver-the-counter hearing aids have been greenlighted by the FDA – your local pharmacist will soon be able to sell you the device you need<figure><img src="https://images.theconversation.com/files/480424/original/file-20220822-38135-2lfool.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The FDA Reauthorization Act of 2017 designated a new class of OTC hearing aids.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/close-up-of-hearing-aid-on-woman-palm-royalty-free-image/1286134759">Heizeng Hu/Moment via Getty Images</a></span></figcaption></figure><p>After a long delay, the Food and Drug Administration issued <a href="https://www.fda.gov/news-events/press-announcements/fda-finalizes-historic-rule-enabling-access-over-counter-hearing-aids-millions-americans">final regulations</a> Aug. 16, 2022, for over-the-counter hearing aids. The <a href="https://www.federalregister.gov/documents/2022/08/17/2022-17230/medical-devices-ear-nose-and-throat-devices-establishing-over-the-counter-hearing-aids">final rule</a> is effective 60 days from its publication, meaning that consumers could see OTC hearing aids hitting the shelves of community pharmacies nationwide by October 2022.</p>
<p>We are a <a href="https://scholar.google.com/citations?user=9Np7_DYAAAAJ&hl=en">pharmacist</a> and <a href="https://scholar.google.com/citations?user=c5UzXW0AAAAJ&hl=en">audiologist</a> who study the potential ways Americans with hearing loss can obtain OTC hearing aids. In a market dominated by <a href="http://concentrationcrisis.openmarketsinstitute.org/industry/hearing-aid-manufacturing/">only a handful of manufacturers</a>, hearing aids that are now available without a prescription will expand access to the estimated <a href="https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing">28.8 million U.S. adults</a> who could benefit from their use.</p>
<h2>A new class of hearing aids</h2>
<p>A <a href="https://www.nidcd.nih.gov/health/hearing-aids">hearing aid</a> is a device worn around the ear that makes desired sounds more audible for people with hearing loss. Hearing aid devices include a microphone, amplifier and miniature loudspeaker to make sounds louder. Traditionally, hearing aids have been accessible only with professional services provided by a licensed hearing aid dispenser or audiologist.</p>
<p>In 2017, the <a href="https://www.congress.gov/115/plaws/publ52/PLAW-115publ52.pdf">FDA Reauthorization Act</a> designated a new class of hearing aids available over the counter to increase the accessibility and affordability of hearing aids for U.S. adults who believe they have mild to moderate hearing loss. These OTC hearing aids could be purchased <a href="https://www.fda.gov/medical-devices/hearing-aids/how-get-hearing-aids">without a medical evaluation by a physician or a fitting by an audiologist</a>.</p>
<p>Before publishing the final rule, the FDA reviewed <a href="https://www.fda.gov/news-events/press-announcements/fda-finalizes-historic-rule-enabling-access-over-counter-hearing-aids-millions-americans">over 1,000 public opinions</a> during the open comment period. The final ruling takes into account a variety of comments related to maximum sound output, product labeling and user controls. Implementation of these regulations is a year overdue, largely because of the COVID-19 pandemic.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/420555/original/file-20210910-26-18azifn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older adult wearing hearing aid." src="https://images.theconversation.com/files/420555/original/file-20210910-26-18azifn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420555/original/file-20210910-26-18azifn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420555/original/file-20210910-26-18azifn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420555/original/file-20210910-26-18azifn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420555/original/file-20210910-26-18azifn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420555/original/file-20210910-26-18azifn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420555/original/file-20210910-26-18azifn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Audiologist practices are often located in urban centers that tend to have a smaller population of older adults.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/ear-machine-royalty-free-image/88200782">cornaile photography/Moment via Getty Images</a></span>
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<p>Pharmacists will play a key role in OTC hearing aid sales. For one, pharmacies are more accessible to Americans than audiology practices. Audiologists <a href="https://doi.org/10.1016/j.socscimed.2019.01.015">tend to be located</a> in metropolitan areas with higher incomes, younger populations and greater insurance coverage, along with a smaller proportion of people who need hearing aids most – namely, older adults. In contrast, <a href="https://doi.org/10.1016/j.japh.2022.07.003">nearly 90% of Americans</a> live within 5 miles of one of the more than 61,000 community pharmacies nationwide.</p>
<p>The ruling will also help get hearing aids into patients’ ears more quickly. It typically takes an average of <a href="https://www.hearingreview.com/uncategorized/marketrak-10-hearing-aids-in-an-era-of-disruption-and-dtc-otc-devices-2">four to five years</a> after people recognize their hearing loss before they see a health care provider, and sometimes an additional six years to obtain a hearing aid device. With this <a href="https://www.congress.gov/bill/115th-congress/house-bill/2430">new law</a>, people will be able to purchase OTC hearing aids as soon as they become aware of their hearing difficulties.</p>
<p>OTC hearing aids will offer a do-it-yourself approach to addressing hearing loss. For example, people might be able to use a smartphone app to <a href="https://dx.doi.org/10.1177%2F2331216518768958">measure and adjust</a> the hearing aid to best fit their hearing needs. <a href="https://digitalcommons.wustl.edu/audio_hapubs/30/">Traditional hearing aids</a> require a professionally administered hearing test and technical features that may allow more customized fine-tuning.</p>
<h2>Increased access at lower costs</h2>
<p>Hearing aid use among people who could benefit from their use <a href="https://www.nidcd.nih.gov/health/statistics/use-hearing-aids-adults-hearing-loss">remains low</a>. The 2017 federal law may help remove barriers to hearing aid ownership by making them not only more accessible, but also more affordable.</p>
<p>Prescription hearing aids cost on average <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2021/07/09/fact-sheet-executive-order-on-promoting-competition-in-the-american-economy/">more than US$5,000 per pair</a>, while the American Academy of Audiology predicts that OTC hearing aids will cost <a href="https://www.audiology.org/consumers-and-patients/managing-hearing-loss/consumers-and-otc-hearing-aids/">$300 to $600 per device</a>. The charges and services associated with prescription hearing aids, which take an <a href="https://www.hearingreview.com/practice-building/practice-management/marketrak-viii-the-impact-of-the-hearing-healthcare-professional-on-hearing-aid-user-success">average of two to three audiology visits</a> to acquire, are <a href="https://obamawhitehouse.archives.gov/sites/default/files/microsites/ostp/PCAST/pcast_hearing_tech_letterreport_final.pdf">not typically covered</a> by Medicare, Medicaid or private insurers. At prices similar to <a href="https://www.irs.gov/businesses/small-businesses-self-employed/local-standards-transportation">monthly car loan payments</a>, hearing health care services are often exclusive to people who have the means to pay high out-of-pocket expenses. Some hearing aids may be eligible for reimbursement using a <a href="https://fsastore.com/fsa-eligibility-list/h/hearing-aids">flexible spending account</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/420552/original/file-20210910-19-l2hsoo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Health provider using otoscope to examine a patient's ear." src="https://images.theconversation.com/files/420552/original/file-20210910-19-l2hsoo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420552/original/file-20210910-19-l2hsoo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420552/original/file-20210910-19-l2hsoo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420552/original/file-20210910-19-l2hsoo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420552/original/file-20210910-19-l2hsoo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420552/original/file-20210910-19-l2hsoo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420552/original/file-20210910-19-l2hsoo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Prohibitive costs and appointment hurdles can discourage patients from obtaining hearing aids.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/close-up-of-a-doctor-checking-the-ear-of-his-male-royalty-free-image/1310935018">Vladimir Vladimirov/E+ via Getty Images</a></span>
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<p>There are also <a href="https://doi.org/10.1177%2F0898264315585505">racial disparities in hearing aid use</a> that could be mitigated by OTC hearing aids. Although Black Americans are more likely to have had a recent hearing test, they are less likely than white older adults to regularly use hearing aids. Such disparities can have potential negative consequences for health and quality of life, including a higher risk of <a href="https://doi.org/10.1159/000485178">cognitive impairment, dementia</a> and <a href="https://doi.org/10.1002/lary.25927">falling</a>, as well as <a href="https://doi.org/10.1177%2F0194599820910377">social isolation, loneliness</a> and <a href="https://doi.org/10.1093/geront/gnz009">depression</a>.</p>
<h2>The pharmacist’s role in OTC hearing aids</h2>
<p>While OTC hearing aids won’t require consultation with a medical professional or a hearing test, pharmacists will play an important role in ensuring their safe and effective use.</p>
<p>Community pharmacists, <a href="https://doi.org/10.1001/jamanetworkopen.2020.9132">among the most accessible of health care providers</a>, are trained to identify, prevent and resolve medication problems. Pharmacists additionally have long helped patients purchase <a href="https://www.amcp.org/policy-advocacy/policy-advocacy-focus-areas/where-we-stand-position-statements/patient-care-services-provided-pharmacist">medical devices and equipment</a> like <a href="https://doi.org/10.1016/j.ptdy.2020.04.014">glucometers for diabetes testing</a> and <a href="https://doi.org/10.1038/s41371-020-0331-7">blood pressure monitors for hypertension</a> without a prescription. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/420556/original/file-20210910-14-ocsq81.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Adult and young child talking to pharmacist at the counter." src="https://images.theconversation.com/files/420556/original/file-20210910-14-ocsq81.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420556/original/file-20210910-14-ocsq81.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420556/original/file-20210910-14-ocsq81.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420556/original/file-20210910-14-ocsq81.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420556/original/file-20210910-14-ocsq81.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420556/original/file-20210910-14-ocsq81.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420556/original/file-20210910-14-ocsq81.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Community pharmacists may soon be able to help patients pick out a hearing aid at their local pharmacy.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/small-family-being-served-by-chemist-at-local-royalty-free-image/1290302520">Tom Werner/DigitalVision via Getty Images</a></span>
</figcaption>
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<p>Community pharmacists are readying themselves to help patients select and purchase OTC hearing aids. In certain cases, pharmacists will refer some patients to audiologists and physicians for additional evaluation, treatment and care. They may also follow up with patients to ensure the device works as expected. To prepare pharmacists for this new role, the University of Pittsburgh has developed <a href="https://pittprofessional.catalog.instructure.com/courses/champ">an online program</a> to teach pharmacists and pharmacy technicians how to help patients safely choose OTC hearing aids.</p>
<p>By providing a lower-cost and more readily available option, OTC hearing aids have the potential to address significant barriers to hearing aid adoption and use.</p>
<p><em>This is an updated version of <a href="https://theconversation.com/you-may-soon-be-able-to-buy-hearing-aids-over-the-counter-at-your-local-pharmacy-165159">an article originally published</a> on Sept. 21, 2021.</em></p><img src="https://counter.theconversation.com/content/184890/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elaine Mormer is a codeveloper of the continuing education course CHAMP: Championing Hearing Using Accessible Medication Experts at the Community Pharmacy, owned by the University of Pittsburgh
</span></em></p><p class="fine-print"><em><span>Lucas Berenbrok is a codeveloper of the continuing education course CHAMP: Championing Hearing Using Accessible Medication Experts at the Community Pharmacy owned by the University of Pittsburgh.</span></em></p>OTC hearing aids promise to increase the accessibility and affordability of the devices for millions of adults who live with untreated mild to moderate hearing loss.Elaine Mormer, Professor of Audiology, University of PittsburghLucas A. Berenbrok, Associate Professor of Pharmacy and Therapeutics, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1641482022-07-19T12:26:00Z2022-07-19T12:26:00ZWhy are drug names so long and complicated? A pharmacist explains the logic behind the nomenclature<figure><img src="https://images.theconversation.com/files/474353/original/file-20220715-18-k6uzvb.jpg?ixlib=rb-1.1.0&rect=178%2C267%2C1886%2C1142&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Having multiple prescriptions is difficult enough to keep track of, let alone ones with complicated names.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-man-staring-at-stack-of-prescription-bottles-royalty-free-image/523006070">Hill Street Studios/Stone via Getty Images</a></span></figcaption></figure><p>At some point in your life, you’ll likely find yourself with a prescription from your doctor to fill. While it’s important to keep track of all the medications you’re taking, that can be hard to do when the names of so many of these drugs are difficult to pronounce and even harder to remember.</p>
<p><a href="https://usf.discovery.academicanalytics.com/scholar/stack/299489/JASMINE-CUTLER">In my role as a pharmacist</a>, I’ve helped countless patients figure out exactly which medication they were taking for what ailment. Some wonder why they were prescribed the medication in the first place, or need help differentiating between drugs with names that seem like complete gibberish.</p>
<p>But there is a rhyme and a reason to drug names. All prescribed medications follow a standard nomenclature that describes what the drug is made of and how it functions.</p>
<h2>Who names drugs?</h2>
<p>Drugs get both a brand, or proprietary, name and a generic name that is nonproprietary. Each is assigned in a slightly different process.</p>
<p>As long as a drug compound isn’t trademarked, drug companies decide on a proprietary brand name for the medications they sell. Usually the brand name relates to the conditions the drug is intended to treat and is easy for both providers and patients to remember but doesn’t follow a standardized naming guideline. For example, the drug Lopressor helps lower blood pressure. </p>
<p>On the other hand, generic drug names all follow a standard nomenclature that helps medical providers and researchers more easily recognize and classify the drug. Lopressor, for example, has a generic name of metoprolol tartrate. The <a href="https://www.ama-assn.org/about/united-states-adopted-names/usan-council">U.S. Adopted Names Council</a>, composed of representatives from the Food and Drug Administration, American Medical Association, U.S. Pharmacopeia and American Pharmacists Association, works with the <a href="https://www.who.int/teams/health-product-and-policy-standards/inn">World Health Organization</a> to assign <a href="https://dx.doi.org/10.1021%2Facs.jmedchem.1c00181">international nonproprietary names, or INNs</a>, to drug compounds. Similar organizations <a href="https://doi.org/10.1016/B978-0-12-820007-0.00002-7">exist internationally</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/474355/original/file-20220715-495-u2t6el.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pharmacist organizing medicine drawer" src="https://images.theconversation.com/files/474355/original/file-20220715-495-u2t6el.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/474355/original/file-20220715-495-u2t6el.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474355/original/file-20220715-495-u2t6el.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474355/original/file-20220715-495-u2t6el.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474355/original/file-20220715-495-u2t6el.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474355/original/file-20220715-495-u2t6el.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474355/original/file-20220715-495-u2t6el.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Generic drugs are named using standard guidelines intended to minimize confusion and aid in classification.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/pharmacist-organizing-the-medicine-drawer-royalty-free-image/1352512002">Marko Geber/DigitalVision via Getty Images</a></span>
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<p>A globally recognized naming process makes an otherwise confusing name game more manageable. It helps the medical community easily learn and categorize newly approved medications and reduce prescribing errors by providing a unique, standard name that reflects each active ingredient in the drug.</p>
<p>For example, several Type 2 diabetes medications fall under one class called glucagon-like peptide-1 (GLP-1) receptor agonists. Although all medications in this class have different brand names, each of the generic versions ends in the suffix “-tide.” This helps health providers identify all the drugs that belong to this medication class. A few examples include Byetta (exenatide), Trulicity (dulaglutide) and Victoza (liraglutide).</p>
<h2>How are generic drug names assigned?</h2>
<p>The <a href="https://www.ama-assn.org/about/united-states-adopted-names/procedure-usan-name-selection">naming process</a> starts when a drug company submits an application to the U.S. Adopted Names Council with a proposed generic name. USAN considers a number of factors when evaluating a name, such as whether it relates to how the drug works, how translatable it is to other languages and whether it is easy to say. In general, the name should be simple – fewer than four syllables long – and should not be easily confused with other existing generic drugs. </p>
<p>Once a name is agreed upon by USAN and the drug company, it is then proposed to the <a href="https://www.who.int/teams/health-product-and-policy-standards/inn/inn_expert_group">INN Expert Group</a>. Sponsored by the World Health Organization, the INN Expert Group is composed of global specialists who represent the pharmaceutical, chemical, pharmacological and biochemical sciences. They may either accept the proposed name or suggest an alternative. Once the drug company, USAN and the INN Expert Group come to an agreement about a name, it is placed in the <a href="https://www.who.int/our-work/access-to-medicines-and-health-products/who-drug-information">WHO Drug Information journal</a> for four months for public comments or objections before final adoption. </p>
<h2>What’s in a generic drug name?</h2>
<p>Generic names follow a <a href="https://www.ama-assn.org/about/united-states-adopted-names/united-states-adopted-names-naming-guidelines">prefix-infix-stem system</a>. The prefix helps distinguish a drug from other drugs in the same class. The infix, used more occasionally, further subclassifies the drug. The stem at the very end of the name indicates the drug’s function and marks its place within the name game.</p>
<p><a href="https://druginfo.nlm.nih.gov/drugportal/jsp/drugportal/DrugNameGenericStems.jsp">Stems</a> are composed of one or two syllables that describe a drug’s biological effects as well as its physical and chemical qualities and structure. Drugs with the same stem share features like the conditions they treat and how they work in the body. The WHO publishes a regularly updated <a href="https://www.who.int/publications/i/item/who-emp-rht-tsn-2018-1">stem book</a> to keep everything in line.</p>
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<p>For example, the stem “-prazole” indicates that the drug is chemically related to a class of compounds called benzimidazoles that have similar functions. As a result, drugs such as lansoprazole (Prevacid), esomeprazole (Nexium) and omeprazole (Prilosec) all treat acid reflux, ulcers and heartburn. The “e” prefix of esomeprazole differentiates it from omeprazole, which has a slightly different chemical structure.</p>
<p>Another common example is drugs that use the stem “stat,” which means enzyme inhibitors. Atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor) all belong to the same class of inhibitors that block a key enzyme in the body’s cholesterol production process. As a result, these cholesterol-reducing “statins” are used to prevent cardiovascular conditions like heart attack and stroke.</p>
<h2>Are there exceptions to the name game?</h2>
<p>Although generic names stay consistent, there have been multiple <a href="https://www.pharmacytimes.com/view/5-notable-drug-name-changes">changes to brand names</a> over the past couple of decades after increases in prescribing and dispensing errors. Some examples include the acid reflux and stomach ulcer drug omeprazole, which was rebranded from Losec to Prilosec because it was frequently confused with the diuretic Lasix. Another example is when the antidepressant Brintellix was changed to Trintellix because it was commonly confused with the blood thinner Brilinta. </p>
<p>Some generic medications may work at <a href="https://theconversation.com/many-medications-affect-more-than-one-target-in-the-body-some-drug-designers-are-embracing-the-side-effects-that-had-been-seen-as-a-drawback-184922">multiple targets in the body</a> and be used for multiple conditions. For example, drugs with the stem “-afil,” such as tadalafil (Cialis), sidenafil (Viagra) and vardenafil (Levitra), belong to a class of drugs that relax smooth muscle and widen the blood vessels. Although commonly prescribed for erectile dysfunction, they can also be used to treat pulmonary arterial hypertension, a specific type of elevated blood pressure that affects the arteries in the heart and lungs.</p>
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<a href="https://images.theconversation.com/files/474354/original/file-20220715-24-38fv83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pharmacist showing patient a box of medications" src="https://images.theconversation.com/files/474354/original/file-20220715-24-38fv83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/474354/original/file-20220715-24-38fv83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474354/original/file-20220715-24-38fv83.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474354/original/file-20220715-24-38fv83.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474354/original/file-20220715-24-38fv83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474354/original/file-20220715-24-38fv83.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474354/original/file-20220715-24-38fv83.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Pharmacists and other health care professionals can help patients decipher complex drug names.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-pharmacist-helping-a-senior-lady-choose-the-royalty-free-image/1352510394">Marko Geber/DigitalVision via Getty Images</a></span>
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<p>In addition, nomenclature guidelines <a href="https://www.who.int/teams/health-product-and-policy-standards/inn/guidance-on-inn">aren’t set in stone</a>, and the U.S. Adopted Names Council anticipates that they will continue to change as newer, more complex substances are discovered, developed and marketed.</p>
<p>For example, a rise in the number of drugs developed with different salts and esters has led to the use of a modified naming process to incorporate the inactive parts of the compound.</p>
<p>As you can guess, it takes health care providers countless months and years to learn and understand this naming process. We are taught the science behind each chemical structure and how it works, which makes it easier to know the rules of the name game. But for those without a background in chemistry and biology, it can be like reading a foreign language.</p>
<p>There are several resources that can help you navigate the drug name game, however. Ask your health care provider or pharmacist if you have questions about how your medication works or what it is used for. They are generally a phone call or visit away.</p><img src="https://counter.theconversation.com/content/164148/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jasmine Cutler does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Believe it or not, medication names are intended to be easy to remember and descriptive of the function they serve in the body.Jasmine Cutler, Assistant Professor of Pharmacotherapeutics, University of South FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1783002022-03-03T07:29:34Z2022-03-03T07:29:34ZGetting urgent medicines in a flood zone can be a life or death challenge<p>I’m writing this from the flooded far north coast of New South Wales, where all around me people are contending with the awful and unexpected consequences of a catastrophic flood. </p>
<p>I have worked in rural health for a long time and this has been the worst I have experienced it. It is well <a href="https://link.springer.com/article/10.1007/s11069-020-03887-z">established</a> that those living in flood-prone areas often already have more financial and health issues than others.</p>
<p>Among those consequences is the need to manage medicines safely, and sometimes urgently find and acquire medicines you need to stay alive and healthy or keep pain at manageable levels.</p>
<p>The far north coast has a high population of older people, many of whom need daily medicines such as insulin to survive.</p>
<p>While I was picking up medicines for a family member this morning, another older person turned up at the pharmacy with a script. She was running out of her medicine today but the pharmacy did not have the required medicines left. She continued her hunt for medicines at the last pharmacy in the area we have access to.</p>
<p>These are just some of the challenges people face when it comes to medicines in a disaster zone.</p>
<h2>From ordinary errand to a life or death challenge</h2>
<p>A week ago, if you needed to top up your medicine supplies, you could pop down to the local chemist. The script would be filled, and supplies plentiful. It would be an easy trip.</p>
<p>Today during floods, an errand like that means confronting challenges such as:</p>
<ul>
<li><p>many chemists being underwater or badly flooded</p></li>
<li><p>the chemists that are open are contending with a surge of demand as people flock there to buy medicines</p></li>
<li><p>power is down in many places, meaning online systems for managing scripts are impossible to access and fridges used to store medicines such as insulin at home are not working</p></li>
<li><p>phone and internet is down or patchy in many places</p></li>
<li><p>petrol is very hard to get and running out, so many people cannot drive to the chemist</p></li>
<li><p>many people have lost their cars too or have water damaged cars</p></li>
<li><p>some people cannot leave home due to landslides or floodwaters</p></li>
<li><p>roads are being cut off and supply lines disrupted because the highway is blocked off</p></li>
<li><p>getting a new script is not as easy as heading to the doctor’s office; some GPs are also flooded in, their practices inundated or not-operational and many are unable to get to work and/or stuck without power, phone or internet.</p></li>
</ul>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1498798439643361280"}"></div></p>
<p>These challenges are not unique to our area nor are they unique to floods. People who have survived <a href="https://theconversation.com/how-to-manage-your-essential-medicines-in-a-bushfire-or-other-emergency-127516">bushfires</a> and other disasters have faced similar issues.</p>
<p>But with disasters predicted to become more frequent and more intense as the climate changes, it does raise the question what systems we can put in place to deal with these challenges in future without putting people at risk.</p>
<h2>What can be done?</h2>
<p>Firstly, if you are in an emergency, depending on your circumstances, please call 000 or contact the SES on 132 500.</p>
<p>When preparing your evacuation plan, ensure you have a list of all your medicines, care plans, scripts, Medicare and other health-care cards details and other important medical information ready. </p>
<p>If an evacuation warning is out for your area, ensure all your information and medicines are packed. Store medicines that need to remain cold in an esky with ice bricks, so you are ready when you need to evacuate. The esky is important; power may not be available for a while when you leave home.</p>
<p>Several apps are available to help in preparing for a disaster and <a href="https://www.healthdirect.gov.au/blog/how-to-take-medicines-safely-in-a-natural-disaster">taking your medicines safely</a>, such as the Red Cross’ <a href="https://www.redcross.org.au/prepare">RediPlan</a> emergency survival plan or the <a href="https://www.nps.org.au/consumers/medicinewise-app?c=getting-started-5cfff60c#what-is-the-medicinewise-app?">MedicineWise app</a>.</p>
<p>If you know a flood is heading your way, it’s also handy to have extra cash at hand. During this flood disaster, electronic payment systems were not working in many places in the Northern Rivers. Having some cash can further reduce already very stressful circumstances.</p>
<p>If you’re flood-affected, in need of medicines and can get yourself to a pharmacy, it may be OK even if you have lost your scripts in the floods. The pharmacist may be able to call <a href="https://www.australianpharmacist.com.au/mick-fanning-takes-pharmacist-to-work-during-floods/?fbclid=IwAR01BothXjaztpxWs2Y2zt--fnH_3BYbhMZS6C7MwF_YJrRRbtLY6mHtvVQ">the GP on their mobile</a>. </p>
<p>If you have internet access, use social media to see if others can help with transport or delivery of medicines. Many people feel powerless during disasters and will be keen to help. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1498537920180862980"}"></div></p>
<p>And there may be some <a href="https://www.health.nsw.gov.au/pharmaceutical/pharmacists/Pages/faq-supply-of-medicines.aspx#owing">strictly limited circumstances</a> under which a pharmacist can provide a small emergency supply of certain medicines <a href="https://www.health.qld.gov.au/__data/assets/pdf_file/0024/1029156/dm-accessing-meds-in-a-disaster.pdf">without a script</a>. </p>
<p><a href="https://www.health.qld.gov.au/__data/assets/pdf_file/0024/1029156/dm-accessing-meds-in-a-disaster.pdf">According</a> to Queensland Health:</p>
<blockquote>
<p>In an emergency situation where you are not able to reach a community pharmacy, your GP’s prescription can be filled by a Queensland Health public hospital pharmacy. However, please be aware that hospitals may not stock the full range of medicines prescribed by your GP, as the needs of hospital and community patients are different.</p>
</blockquote>
<p>You can use <a href="https://www.myhealthrecord.gov.au/">My Health Record</a> to get certain key details on your medicines and health details, if you’ve got internet access.</p>
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<p>After the floods, it is important to look at <a href="https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/after-a-flood/faq-20058421#:%7E:text=Any%20medications%20%E2%80%94%20pills%2C%20liquids%2C,contaminated%20water%20should%20be%20discarded">replacing medicines</a> that have been in contact with flood water or other contaminated water. This includes pills, liquids, injections, inhalers or creams. Contact your doctor or pharmacist as soon as possible and organise replacement medications.</p>
<p>You can also contact the NPS Medicines Line 1300 MEDICINE (1300
633 424) or the healthdirect helpline (1800 022 222 or <a href="https://www.healthdirect.gov.au/nurse-on-call#:%7E:text=Call%20NURSE%2DON%2DCALL%20on,apply%20from%20anywhere%20in%20Victoria.">Nurse on Call</a> in Victoria) if you are unsure or have <a href="https://www.healthdirect.gov.au/blog/how-to-take-medicines-safely-in-a-natural-disaster">questions about your medicines</a>.</p>
<p>More broadly, access to medicines during a natural disaster is complex, and we need to continue strong partnerships and collaboration between organisations to ensure access during disasters.</p>
<p>Having a good spread of chemists around different parts of a town or rural areas helps boost the chances that even if some are hit by disasters, others are able to operate and provide people with medicines (which is what we have seen in the 2022 floods in some areas).</p>
<p>Privately owned and hospital-run helicopters have been used to get medicines to residents in flood-affected areas of Brisbane; ensuring disaster-prone regions have the infrastructure and machines needed for this kind of help is important.</p>
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<p>COVID forced us to think creatively about delivering medical supplies to people who need them but are <a href="https://www.ppaonline.com.au/programs/covid-19-programs/covid-19-home-medicine-service">unable to visit a pharmacy</a>. This shows what’s possible when needs must be met. </p>
<p>Thinking carefully about people’s health during and after disaster is crucial to building disaster resilience. Ensuring uninterrupted supplies, extra support for vulnerable people and access to medicines is a core part of that goal.</p><img src="https://counter.theconversation.com/content/178300/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sabrina Pit has received funding in the past from NHMRC.</span></em></p>Thinking carefully about people’s health during and after disaster is crucial to building disaster resilience. Ensuring access to medicines is a core part of that goal.Sabrina Pit, Honorary Senior Research Fellow at the University of Sydney, Honorary Adjunct Research Fellow, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1671782021-09-02T05:27:41Z2021-09-02T05:27:41ZThinking of trying ivermectin for COVID? Here’s what can happen with this controversial drug<figure><img src="https://images.theconversation.com/files/419019/original/file-20210902-18-njx5bl.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C997%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/clamart-france-august-22-2021-box-2028959327">Shutterstock</a></span></figcaption></figure><p>Westmead Hospital in Sydney’s west says it has treated a patient <a href="https://www.news.com.au/lifestyle/health/health-problems/westmead-hospital-patient-overdoses-on-online-cure-for-covid19/news-story/d5cc0998a98791af3b43bcaef42578b9">who overdosed</a> after taking the drug ivermectin, an unproven and potentially dangerous treatment for COVID-19.</p>
<p>The person went to hospital seeking treatment for diarrhoea and vomiting side-effects, after taking the drug, which is usually used to treat parasites. The person had ordered this and other unproven COVID “cures” online.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1433020559349084160"}"></div></p>
<p>While the patient did not die, <a href="https://www.tga.gov.au/covid-19-treatments-information-consumers-and-health-professionals">health authorities are concerned</a> at the number of people taking ivermectin, and warn against it for anyone else who may have COVID symptoms or has been diagnosed with the virus.</p>
<p>Other known ivermectin side-effects range from mild to the life-threatening, including seizures and coma.</p>
<h2>Why are people taking it?</h2>
<p>Ever since researchers showed ivermectin could kill SARS-CoV-2 (the virus that causes COVID-19) in the laboratory, there has been interest in whether the drug would also work to kill the virus <a href="https://theconversation.com/head-lice-drug-ivermectin-is-being-tested-as-a-possible-coronavirus-treatment-but-thats-no-reason-to-buy-it-135683">in the human body</a>.</p>
<p>So far, there is <a href="https://theconversation.com/a-major-ivermectin-study-has-been-withdrawn-so-what-now-for-the-controversial-drug-164627">no clinical evidence</a> it works to treat or prevent COVID-19. And there is widespread consensus people should not take ivermectin at home for COVID-19. </p>
<p>Organisations that recommend against it include: the <a href="https://www.who.int/news-room/feature-stories/detail/who-advises-that-ivermectin-only-be-used-to-treat-covid-19-within-clinical-trials">World Health Organization</a>, Australia’s <a href="https://covid19evidence.net.au/faqs/#Ivermectin">National COVID-19 Clinical Evidence Taskforce</a> and <a href="https://www.nps.org.au/ivermectin-and-covid-19">NPS Medicinewise</a>, the United State’s <a href="https://www.fda.gov/animal-veterinary/animal-health-safety-and-coronavirus-disease-2019-covid-19/cvm-letter-veterinarians-and-retailers-help-stop-misuse-animal-ivermectin-prevent-or-treat-covid-19">Food and Drug Administration</a>, and the <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full">Cochrane Library</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-major-ivermectin-study-has-been-withdrawn-so-what-now-for-the-controversial-drug-164627">A major ivermectin study has been withdrawn, so what now for the controversial drug?</a>
</strong>
</em>
</p>
<hr>
<h2>How are people getting hold of it?</h2>
<p>Despite this, <a href="https://www.theguardian.com/australia-news/2021/sep/01/australian-pharmacists-report-rise-in-customers-refusing-to-say-what-ivermectin-prescription-is-for">community pharmacists</a> have reported increased demand for ivermectin, with people seeking the drug as a possible COVID treatment.</p>
<p>In Australia, ivermectin is <a href="https://www.tga.gov.au/covid-19-treatments-information-consumers-and-health-professionals">approved to treat parasite infections in humans</a>. It’s also widely used in veterinary medicine to treat and prevent parasite infections.</p>
<p>However, as a prescription-only human medicine (known as <a href="https://www.healthdirect.gov.au/medicines/brand/amt,3069011000036101/stromectol">schedule 4</a>), you can only access ivermectin legally in Australia after approval from a doctor.</p>
<p>This is because, like all medicines, ivermectin is not 100% safe. It does have possible harmful side-effects and a doctor’s judgement is necessary to decide if ivermectin is safe and appropriate for each patient.</p>
<p>So ivermectin is currently only recommended to treat and prevent COVID-19 when used <a href="https://covid19evidence.net.au/faqs/#Ivermectin">as part of a clinical trial</a>, where patients can be more safely selected and carefully monitored.</p>
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<p>As well as more patients presenting to pharmacies with scripts, the Therapeutic Goods Administration <a href="https://www.tga.gov.au/media-release/risks-importing-ivermectin-treatment-covid-19">warns</a> about the danger of importing ivermectin products of unknown quality, bought over the internet.</p>
<p>This is risky because products may not contain the stated drug, may contain dangerous contaminants or much more of the drug than thought, which may result in an overdose.</p>
<p>Of most concern are reports from <a href="https://www.abc.net.au/radio/programs/worldtoday/warnings-against-ivermectin/13524184">Australia</a> and <a href="https://www.theguardian.com/commentisfree/2021/aug/31/a-human-is-not-a-horse-so-why-is-a-livestock-drug-sweeping-america-covid-ivermectin">overseas</a> of people buying and taking ivermectin products intended for animal use. People may be resorting to these types of products where they have been unable to access a script for human formulations of ivermectin.</p>
<h2>What does it do to your body?</h2>
<p>We know very little about what the drug does to humans, and the little we do know mostly comes from <a href="https://pubmed.ncbi.nlm.nih.gov/34149064/">its use in animals</a>.</p>
<p>When taken at the recommended dose, the drug is generally well tolerated. But ivermectin is known to cause mild side-effects such as diarrhoea, nausea, dizziness and sleepiness. Less common, but serious, side-effects include severe skin rashes and effects on the nervous system (causing tremor, confusion and drowsiness). </p>
<p>In higher doses, and overdose cases, these side-effects can be <a href="https://www.fda.gov/consumers/consumer-updates/why-you-should-not-use-ivermectin-treat-or-prevent-covid-19">more severe</a>. These include low blood pressure, problems with balance, seizures, liver injury, and it can even <a href="https://www.nejm.org/doi/full/10.1056/NEJMc1917344">induce comas</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-misinformation-is-a-global-issue-but-which-myth-you-fall-for-likely-depends-on-where-you-live-143352">Coronavirus misinformation is a global issue, but which myth you fall for likely depends on where you live</a>
</strong>
</em>
</p>
<hr>
<h2>The take-home message</h2>
<p>The public is understandably interested in medicines to treat and prevent COVID-19. However, <a href="https://theconversation.com/au/topics/covid-misinformation-103292">misinformation about ivermectin and others continues to circulate</a>. </p>
<p><a href="https://theconversation.com/how-well-do-covid-vaccines-work-in-the-real-world-162926">COVID-19 vaccination</a> remains the best way to reduce the risk of serious illness and death from COVID-19. Australia’s <a href="https://covid19evidence.net.au/">National COVID-19 Clinical Evidence Taskforce</a> provides the most up-to-date information about COVID-19 treatments and is a reliable source of information as new knowledge emerges.</p>
<hr>
<p><em>If you or a family member take ivermectin and have strong side-effects you should seek medical advice. Call the <a href="https://www.health.gov.au/contacts/poisons-information-centre">Poisons Information Centre</a> on 131 126. For life-threatening symptoms, call 000 for an ambulance.</em></p><img src="https://counter.theconversation.com/content/167178/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is Fellow of the Royal Australian Chemical Institute and a member of the Australasian Pharmaceutical Science Association. Nial is science director of the medicinal cannabis company Canngea Pty Ltd, a board member of the Australian Medicinal Cannabis Association, and a Standards Australia committee member for sunscreen agents.</span></em></p><p class="fine-print"><em><span>Andrew McLachlan receives research funding from the NHMRC and the Sydney Pharmacy School receives research scholarship funding from GSK for a PhD student under his supervision. Andrew has served as a paid consultant on Australian government committees related to medicines regulation. Andrew does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article.</span></em></p><p class="fine-print"><em><span>Slade Matthews has served the Australian Therapeutic Goods Administration as an external evaluator for the Therapeutic Goods Evaluation Panel. He also serves on the NSW Poisons Advisory Committee as the pharmacologist member. Slade does not work for, consult or own shares in or receive funding from any company of organisation that would benefit from this article.</span></em></p>Side-effects for this unproven and potentially dangerous treatment range from vomiting and diarrhoea to seizures and a coma.Nial Wheate, Associate Professor of the Sydney Pharmacy School, University of SydneyAndrew McLachlan, Head of School and Dean of Pharmacy, University of SydneySlade Matthews, Senior Lecturer, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1618942021-06-10T20:09:05Z2021-06-10T20:09:05ZHere’s how pharmacies could boost Australia’s COVID vaccine rollout<p>Under Australia’s original COVID-19 vaccination rollout plan, community pharmacies were meant to be involved in administering vaccines <a href="https://www.health.gov.au/sites/default/files/documents/2021/01/community-pharmacy-covid-19-vaccine-rollout-from-phase-2a-community-pharmacy-covid-19-vaccine-rollout-from-phase-2a-may-2021-onwards.pdf">from phase 2a</a>. </p>
<p>Phase 2a includes <a href="https://www.health.gov.au/sites/default/files/documents/2021/01/covid-19-vaccination-australia-s-covid-19-vaccine-national-roll-out-strategy.pdf">all adults over 50</a>, among other priority groups, and began <a href="https://theconversation.com/im-over-50-and-can-now-get-my-covid-vaccine-is-the-astrazeneca-vaccine-safe-does-it-work-what-else-do-i-need-to-know-159814">at the beginning of May</a> via mass vaccination hubs, followed by <a href="https://theconversation.com/im-over-50-and-can-now-get-my-covid-vaccine-can-i-talk-to-the-gp-first-do-i-need-a-painkiller-what-else-do-i-need-to-know-160357">GP clinics</a>. </p>
<p>We’re now technically into phase 2b, with certain age groups <a href="https://www.abc.net.au/news/2021-06-03/act-vaccination-expansion-makes-thousands-40-49-eligible/100186728">under 50</a> newly eligible, depending on the state or territory. </p>
<p>Pharmacists have been found to be capable, willing and ready to help with Australia’s vaccine rollout. But with the exception of <a href="https://www.psa.org.au/a-day-to-celebrate/">Queensland</a>, where 49 regional and remote community pharmacies are now allowed to deliver the vaccine, we have yet to see the government engage pharmacists in a meaningful way. </p>
<h2>A bit of background</h2>
<p>On <a href="https://www.ppaonline.com.au/vaccine-eoi">February 5</a> this year, the federal government called for expressions of interest from community pharmacies to be involved with the vaccine rollout. Approximately 3,900 of the <a href="https://www.guild.org.au/__data/assets/pdf_file/0020/12908/Vital-facts-on-community-pharmacy.pdf">5,700 pharmacies nationwide</a> were deemed “suitable”.</p>
<p>The Pharmacy Guild of Australia <a href="https://www.theaustralian.com.au/nation/pharmacy-guild-asks-for-right-to-give-jab/news-story/02ac953ce406c76a200c810bb167bf17">has estimated</a> allowing these pharmacies to administer the vaccine would accelerate Australia’s vaccination rollout by three months. Their modelling also suggested involving the pharmacy sector would save the government A$77 million.</p>
<p>In April, <a href="https://www.pm.gov.au/media/national-cabinet-4">National Cabinet</a> agreed pharmacies could be engaged in the states’ and territories’ rollout plans in locations where there are no or limited other places for people to be vaccinated.</p>
<p>In May, Federal Health Minister Greg Hunt <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/further-strengthening-the-covid-19-vaccine-rollout-through-primary-care">announced</a> up to 56 community pharmacies in regional Queensland would be approved to administer COVID vaccines, following a proposal from the Queensland government. </p>
<p>We’ve seen that <a href="https://www.psa.org.au/a-day-to-celebrate/">begin this week</a>, and it’s great news for those Queensland communities with no medical practice. It’s expected jurisdictions with large hinterlands including <a href="https://www.theage.com.au/politics/federal/end-vaccine-frustration-and-let-pharmacies-join-the-rollout-pharmacy-guild-20210609-p57zkr.html">New South Wales and Western Australia</a> will follow soon.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1395185521769418752"}"></div></p>
<p>But we haven’t seen engagement of pharmacies more broadly, beyond filling the gaps that exist outside city centres (and even that we’ve only seen in Queensland so far). At the Australian Pharmacy Professional Conference in May, <a href="https://www.greghunt.com.au/transcript-speech-australian-pharmacy-professional-conference-gold-coast/">Minister Hunt stated</a> the pharmacy sector would need to wait until “the latter part of the year” to be involved.</p>
<p>In personal communications with the department of health, inadequate supplies of vaccines at the state and territory level has been cited as the reason for delayed implementation of pharmacy-based vaccination, even in a “filling the gap” role.</p>
<p>This doesn’t help those Australians living in towns or in outer suburbs of the cities where there is an approved pharmacy but no GP. Nor does it help people whose GPs don’t provide COVID-19 vaccinations, or who are elderly or frail and unable to travel to mass vaccination hubs.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pay-pharmacists-to-improve-our-health-not-just-supply-medicines-124641">Pay pharmacists to improve our health, not just supply medicines</a>
</strong>
</em>
</p>
<hr>
<h2>Pharmacists are well-placed to deliver vaccines</h2>
<p>Pharmacists have been a fundamental part of Australia’s vaccination workforce <a href="https://www.psa.org.au/pharmacist_administered_vaccinations/">since 2014</a>. Depending on the state, pharmacists can administer influenza, whooping cough, measles, mumps, rubella, meningococcal, diphtheria and COVID-19 vaccines.</p>
<p>Approval for pharmacies to offer vaccination requires training to the same skill level as other vaccinators (such as nurses and doctors), appropriate private space within the pharmacy, and the capacity to upload patients’ vaccination records to the Australian Immunisation Register.</p>
<p>Once pharmacies get the green light for greater involvement, the lead time for the profession to come on board will be short as these factors are largely already in place.</p>
<p>With the expectation of assisting with the COVID-19 vaccination program, we’ve seen an upsurge in pharmacists completing vaccination training this year.</p>
<figure class="align-center ">
<img alt="A young female pharmacist uses a tablet computer." src="https://images.theconversation.com/files/405578/original/file-20210610-27-sau218.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/405578/original/file-20210610-27-sau218.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/405578/original/file-20210610-27-sau218.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/405578/original/file-20210610-27-sau218.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/405578/original/file-20210610-27-sau218.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/405578/original/file-20210610-27-sau218.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/405578/original/file-20210610-27-sau218.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many pharmacists are trained in vaccination.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Storage changes will make it easier</h2>
<p>The Therapeutic Goods Administration recently <a href="https://www.tga.gov.au/behind-news/tga-approves-more-flexible-storage-conditions-pfizer-biontech-covid-19-vaccine">approved changes</a> to the storage requirements of the Pfizer-BioNTech vaccine. </p>
<p>This COVID vaccine belongs to a family of a new technology called mRNA vaccines, and initially required storage at around -60°C. During development of the mRNA vaccines, scientists didn’t know whether the vaccines would be <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/biontech-nearing-request-approval-longer-lasting-version-covid-vaccine-2021-05-04/">stable in a refrigerator</a>, but testing has since demonstrated they can be stored safely for one month at a normal fridge temperature of 2-8°C. </p>
<p>The capability to store vaccine in unopened vials in normal fridges, as opposed to ultra-cold freezers, will allow greater flexibility in vaccine delivery. This will be particularly useful for remote communities where deliveries can be complicated. </p>
<p>The storage change also enables administration of COVID-19 mRNA vaccines in community pharmacies which all have fridges with temperature monitors.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/were-gathering-data-on-covid-vaccine-side-effects-in-real-time-heres-what-you-can-expect-158945">We're gathering data on COVID vaccine side effects in real time. Here's what you can expect</a>
</strong>
</em>
</p>
<hr>
<h2>Addressing vaccine hesitancy</h2>
<p>With Australia starting COVID-19 vaccination later than many places and <a href="https://ourworldindata.org/covid-vaccinations">slipping further behind</a> comparable countries, all available resources should be brought to bear in assisting the population to accept and access vaccination.</p>
<p>We can look overseas to see government programs which engage community pharmacy in COVID-19 vaccination. </p>
<p>In the United States, for example, a <a href="https://www.cdc.gov/vaccines/covid-19/retail-pharmacy-program/index.html">collaboration</a> between national and state governments and 40,000 pharmacies makes it easier for people to access COVID-19 vaccination locally, improving vaccine uptake and decreasing the logistical and operational burden on health departments.</p>
<p>Also in the US, the <a href="https://www.cdc.gov/vaccines/covid-19/long-term-care/pharmacy-partnerships.html">Pharmacy Partnership for Long-Term Care Program</a> involves community pharmacies vaccinating residents and staff on-site at more than 62,000 residential aged-care facilities.</p>
<figure class="align-center ">
<img alt="A male pharmacist talks with a female customer." src="https://images.theconversation.com/files/405576/original/file-20210610-25-19pgvj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/405576/original/file-20210610-25-19pgvj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/405576/original/file-20210610-25-19pgvj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/405576/original/file-20210610-25-19pgvj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/405576/original/file-20210610-25-19pgvj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/405576/original/file-20210610-25-19pgvj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/405576/original/file-20210610-25-19pgvj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pharmacists may be able to allay the concerns of some people who are hesitant about COVID vaccination.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>While issues of global supply and vaccine storage have affected distribution, public concern about efficacy and side effects have contributed to vaccine hesitancy and affected uptake. </p>
<p>Public health messaging is important but these are complex and personal matters. Many people have questions, like “which vaccine is best for me taking into account my medical situation?” and “what are the potential side effects?”. Pharmacists are well-placed to answer these sorts of questions. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/4-ways-australias-covid-vaccine-rollout-has-been-bungled-158225">4 ways Australia's COVID vaccine rollout has been bungled</a>
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<img src="https://counter.theconversation.com/content/161894/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Jackson is President of the Victorian Branch of the Pharmaceutical Society of Australia and has been engaged in negotiation within the profession and with the Victorian government on how and when pharmacists may be engaged in COVID-19 vaccination. </span></em></p><p class="fine-print"><em><span>Harry Al-Wassiti received funding from Monash University and The Medical Research Future Fund (MRFF) to develop mRNA Covid19 vaccine. He collaborates, consults for or and receives funding from Pharmaceutical industry collaborators biotechnology and government bodies involved in the technological development of vaccines. No affiliation with Pharmacy councils or assoications.
</span></em></p>Community pharmacies and pharmacists are important resources in Australia’s vaccine rollout, and right now they’re being under-utilised.John Jackson, Researcher, Faculty of Pharmacy and Pharmaceutical Sciences, Monash UniversityHarry Al-Wassiti, Bioengineer and Research Fellow, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1537962021-01-31T18:55:13Z2021-01-31T18:55:13ZDoctors must now prescribe drugs using their chemical name, not brand names. That’s good news for patients<figure><img src="https://images.theconversation.com/files/381267/original/file-20210129-21-1wumjzy.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6006%2C4007&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shuterstock</span></span></figcaption></figure><p>From today (February 1), when you receive a prescription in Australia, it will list the name of the medication’s <a href="https://www.pbs.gov.au/info/general/active-ingredient-prescribing">active ingredient</a> rather than the brand name. So, for example, instead of receiving a prescription for Ventolin, your script will say “salbutamol”. </p>
<p>This national legislation change, called <a href="https://www.safetyandquality.gov.au/sites/default/files/2020-12/fact_sheet_-_active_ingredient_prescribing_-_guidance_for_australian_prescribers_0.pdf">active ingredient prescribing</a>, is long overdue for Australian health care. </p>
<p>Using the name of the drug — instead of the brand name, of which there are often many — will simplify how we talk about and use medications. </p>
<p>This could have a range of benefits, including fewer <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.12805">medication errors</a> by both doctors and patients.</p>
<h2>What is an active ingredient?</h2>
<p>The <a href="https://www.tga.gov.au/book/prominence-active-ingredients-medicine-labels">active ingredient</a> describes the main chemical compound in the medicine that affects your body. It’s the ingredient that helps control your asthma or headache, for example. </p>
<p>Drugs are tested to ensure they contain exactly <a href="https://www.tga.gov.au/publication/australian-regulatory-guidelines-prescription-medicines-argpm">the same active ingredients</a> regardless of which brand you buy.</p>
<p>There’s only one active ingredient name for each type of medical compound, although they may come in different strengths. Some types of medications may contain multiple active ingredients, such as Panadeine Forte, which contains both paracetamol and codeine.</p>
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<strong>
Read more:
<a href="https://theconversation.com/prescribing-generic-drugs-will-reduce-patient-confusion-and-medication-errors-77093">Prescribing generic drugs will reduce patient confusion and medication errors</a>
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<h2>There can be several brand names</h2>
<p>Until now, doctors and other prescribers have used a mixture of brand and active ingredient names when prescribing medicines. An Australian study found doctors used brand names for <a href="https://www.publish.csiro.au/AH/AH12009">80.5% of prescriptions</a>. </p>
<p>Different brands are available for most medications — <a href="https://www.mja.com.au/journal/2011/195/11/whats-name-brand-name-confusion-and-generic-medicines">up to 12</a> for some. Combined with active ingredient names, this equates to thousands of different names — too many for any patient, doctor, nurse or pharmacist to remember. </p>
<figure class="align-center ">
<img alt="A senior man taking a tablet. There are a variety of medications on the table." src="https://images.theconversation.com/files/381268/original/file-20210129-23-15x62ie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/381268/original/file-20210129-23-15x62ie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381268/original/file-20210129-23-15x62ie.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381268/original/file-20210129-23-15x62ie.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381268/original/file-20210129-23-15x62ie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381268/original/file-20210129-23-15x62ie.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381268/original/file-20210129-23-15x62ie.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Older people are at higher risk of making medication errors, as they tend to take more medications.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Here’s an example of the problem.</p>
<p>I ask John, a patient whom I’ve just met, whether he takes cholesterol medications, commonly called statins. The active ingredient names for this group of medications all end in “statin” (for example, pravastatin, simvastatin).</p>
<p>“Ummm, I’m not sure, is it a blue pill?” John asks.</p>
<p>“It could come in many colours. It might be called atorvastatin, or Lipitor,” I reply. “Perhaps rosuvastatin, or Crestor, or Zocor?”</p>
<p>“Ah yes, Crestor, I am taking that,” John exclaims, after deliberating for some time.</p>
<p>This is a common and important conversation, but could be simpler for both of us if John was familiar with the active ingredient name.</p>
<p>And while we did eventually come to the answer, this medication could have easily been overlooked, by both John and myself. This may have significant implications and interact with other medicines I might prescribe.</p>
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<strong>
Read more:
<a href="https://theconversation.com/ive-heard-covid-is-leading-to-medicine-shortages-what-can-i-do-if-my-medicine-is-out-of-stock-153628">I've heard COVID is leading to medicine shortages. What can I do if my medicine is out of stock?</a>
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<h2>Cause for confusion</h2>
<p>The main problem with using brand names for medications is the potential for confusion, as we see with John.</p>
<p>A prescription written using a brand name doesn’t mean you can’t buy other brands. And your pharmacist may offer to substitute the brand specified for an equivalent generic drug. So, people often leave the pharmacy with a medication name or package that bears no resemblance to the prescription.</p>
<p>When the terms we use to describe medicines in conversation, on prescriptions and what’s written on the medication packet can all be different, patients might not understand which medications they’re taking, or why. </p>
<p>This often leads to doubling up (taking two brands of the same medication), or forgetting to take a certain medication because the name on the package doesn’t match what’s written on your medication list or prescription.</p>
<p>Confusion resulting from using brand names has been associated with serious medication errors, including <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/211398?casa_token=hA41G4MI1ZQAAAAA:JJTT5NB6FOTsn-ZluZclU9Xxx942FN1mcbjcJ-zJlhJ6SNJc8GoIL0eyE1fdb55JV1s1gzu9aNg">overdoses</a>. Elderly people are the most susceptible, as they’re most likely to take multiple medications.</p>
<p>Even when the confusion doesn’t cause harm, it can be problematic in other ways. If patients don’t understand their medicines, they may be less likely to be proactive in making decisions with their doctor or pharmacist about their health care.</p>
<p>Health professionals can also get confused, potentially leading to <a href="https://www.ismp.org/resources/progress-preventing-name-confusion-errors">prescribing errors</a>.</p>
<h2>What are the benefits of active ingredient prescribing?</h2>
<p>The main benefit of the switch is to simplify the language around medications. </p>
<p>Once we become accustomed to using one standardised name for each medicine, it will be easier to talk about medicines, whether with a family member, pharmacist or doctor. </p>
<p>The better we understand the medications we’re using, the <a href="https://www.sciencedirect.com/science/article/pii/S0025619614003875?casa_token=s6dZMe3HH58AAAAA:ZEY1c6ltPyfJBMuOw6XHH6PdGdAuLpkn6s3WP0gmoSo8UwC7pD-vpwMwqqjp81V9KCbp6PcTtw">fewer errors we make</a>, and the more control we can take over our medication use and decisions.</p>
<figure class="align-center ">
<img alt="A pharmacist studies a woman's prescription." src="https://images.theconversation.com/files/381269/original/file-20210129-13-6xid6s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/381269/original/file-20210129-13-6xid6s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381269/original/file-20210129-13-6xid6s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381269/original/file-20210129-13-6xid6s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381269/original/file-20210129-13-6xid6s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381269/original/file-20210129-13-6xid6s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381269/original/file-20210129-13-6xid6s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A pharmacist can let you know which brands of your medication are are available.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>This change will also serve to promote choice.</p>
<p>When you’re prescribed a medicine with a certain name, you’re more likely to buy that brand. In some cases there may be generic medicines that are cheaper and just as effective. Or there may be other forms of the medication that better suit your needs, such as a capsule only available in another brand.</p>
<h2>Not too much will change</h2>
<p>This new rule is not expected to lead to extra work for doctors, pharmacists or other health professionals who prescribe medicines, as most clinical software will make the transition automatically.</p>
<p>Doctors can elect to still include the brand name on the prescription, if they feel it’s important for the patient. But aside from some limited exceptions, the active ingredient name will need to be listed, and will be listed first.</p>
<p>Some active ingredient names may be a bit longer and more complex than certain brand names, so there might be a period of adjustment for consumers. </p>
<p>But in the long term, this change will streamline terminology around medicines and make things easier, and hopefully safer, for everyone.</p>
<p>Next time you receive your prescription, have a look at the name of the active ingredient. Remember it, and use that name when you talk to your family, doctor and pharmacist.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/boomers-have-a-drug-problem-but-not-the-kind-you-might-think-127682">Boomers have a drug problem, but not the kind you might think</a>
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<img src="https://counter.theconversation.com/content/153796/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Grant received funding from the National Health and Medical Research Council.</span></em></p>The language used to describe medications is confusing, with multiple names for the same drug. A change to prescribing rules from today should go a long way to addressing this issue.Matthew Grant, Palliative Medicine Physician, Research Fellow, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1536282021-01-20T19:07:54Z2021-01-20T19:07:54ZI’ve heard COVID is leading to medicine shortages. What can I do if my medicine is out of stock?<figure><img src="https://images.theconversation.com/files/379646/original/file-20210120-15-1rkrr09.jpg?ixlib=rb-1.1.0&rect=0%2C5%2C1000%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/middle-eastern-male-pharmacist-wearing-protective-1827869804">from www.shutterstock.com</a></span></figcaption></figure><p>You’ve just come from your monthly GP appointment with a new script for your ongoing medical condition. But your local pharmacy is out of stock of your usual medicine. Your condition is serious, and without it, your health is likely to suffer. What can you do?</p>
<p>While <a href="https://www.tga.gov.au/hubs/medicine-shortages">medicine shortages</a> happen from time to time, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235598/">researchers</a> and <a href="https://www.abc.net.au/news/2021-01-20/australia-post-coronavirus-medication-shortage/13065076">the media</a> report COVID-19 is causing more shortages than normal for many life-saving medicines. In Australia, <a href="https://www.abc.net.au/news/2021-01-20/australia-post-coronavirus-medication-shortage/13065076">media reports indicate</a> this includes some medications used to treat hyperthyroidism, high blood pressure, or allergies.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1351605107289296896"}"></div></p>
<p>Unfortunately, you’ll only likely find out if this applies to you when you reach the pharmacy. If that happens, there are a few ways you may be able to obtain your prescription.</p>
<p>But if the stock shortage will last for an extended period of time, and you cannot find a supply, your doctor may need to consider prescribing a different medication. </p>
<h2>Why are there shortages?</h2>
<p>Unfortunately, medicine shortages are an all too common problem of the modern health-care system. When our medicines come from a global supply chain — where raw ingredients are made in one country, processed into medicines in another, then freighted by sea or air to Australia — a single break in the supply chain can result in medicines going out of stock.</p>
<p>So there have been calls for Australia <a href="https://www.afr.com/politics/federal/australia-looks-to-boost-drug-manufacturing-20200413-p54je6">to set up its own medicines manufacturing base</a>. But even if we do, that doesn’t help now during COVID.</p>
<p>Medicines shortages is a <a href="https://www.who.int/medicines/publications/druginformation/WHO_DI_30-2_Medicines.pdf?ua=1">growing issue globally</a>. That’s because of increasing demand, higher quality standards and fewer manufacturing sites. </p>
<p>Shortages have also been exacerbated in 2020 due to COVID-19. When workers are <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30459-1/fulltext">locked out of the factory</a> because of a local outbreak, medicines don’t get made. And when we <a href="https://www.freightaustralia.gov.au/annual-report/the-year-that-was/covid-19-impacts-on-freight">restrict the number of flights into Australia</a>, that prevents medicines from arriving.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/new-law-wont-safeguard-medicine-supply-itll-only-ensure-we-know-theres-a-shortage-103100">New law won't safeguard medicine supply – it'll only ensure we know there's a shortage</a>
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<p>When a manufacturer knows there is likely to be a medicine shortage, for any reason, they are required to inform the Australian Therapeutic Goods Administration (TGA) so pharmacies can make other arrangements, such as stocking up on alternatives or sourcing supply from other companies.</p>
<p>When the medicine shortage is considered to have a critical patient impact, or if it is in the interest of the public to know about the shortage, then the information is added to the TGA’s <a href="https://apps.tga.gov.au/prod/MSI/search">shortages website</a>, which the public can search.</p>
<p>But this information is only useful at the government and wholesaler level; local GPs and community pharmacists don’t have the time to check the site every day.</p>
<p>Dealing with shortages efficiently is important because their impacts are wide ranging. Shortages <a href="https://doi.org/10.1371/journal.pone.0215837">result in</a> higher costs to patients when they have to buy branded rather than generic formulations; more drug errors due to the different strengths and brands dispensed; more side-effects and higher death rates because of changes to less appropriate medicines; and more complaints from patients.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pharmacist taking medicine off shelf" src="https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There’s not always enough medicine to go round. And shortages can affect a patient’s health.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmacist-filling-prescription-pharmacy-drugstore-1281072733">www.shutterstock.com</a></span>
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<h2>What if your local pharmacy is out of stock?</h2>
<p>It is best to speak to your pharmacist about your options when your medication is out of stock. There may be other brands still available and appropriate to swap. Alternatively, your pharmacist could dispense a different strength of the same medication. <a href="https://www.psa.org.au/coronavirus/regulatory-changes/">Regulations</a> brought in during the pandemic have allowed pharmacists to do this to help with medicine supply. </p>
<p>If there are no appropriate substitutes, in rare instances a local compounding pharmacy can manufacture certain products in store.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/how-to-manage-your-essential-medicines-in-a-bushfire-or-other-emergency-127516">How to manage your essential medicines in a bushfire or other emergency</a>
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<p>If none of your local pharmacies stock your medicine, your next option is for an <a href="https://mymedkit.com.au/">Australian online pharmacy</a> to fill your script. It may be able to ship your medicine from another city or state.</p>
<p>It is not legal or safe for you personally to order prescription medications from online overseas suppliers. This is because they may not have been manufactured to Australian standards, and may be unsafe. But your pharmacist may do so on your behalf, under a special provision called <a href="https://www.tga.gov.au/ws-s19a-index">section 19A</a>.</p>
<p>If all else fails, you may need to contact your doctor about changing to a different medication. There are often many alternatives in the same drug class that work in the same, or very similar, way.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-should-you-do-with-your-unused-medicine-81406">Health Check: what should you do with your unused medicine?</a>
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<p>Finally, and especially during COVID-19, for a large number of medicines pharmacists are only allowed to provide a <a href="https://www.tga.gov.au/media-release/limits-dispensing-and-sales-prescription-and-over-counter-medicines">maximum of one month’s supply</a> to each patient. </p>
<p>So if your medicine is actually in stock and you want extra, just in case, then by law they may not be able to dispense it to you. This is to prevent panic buying and to ensure the wider community has steady access to medicine; that is, to prevent further shortages.</p>
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<img src="https://counter.theconversation.com/content/153628/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is Fellow of the Royal Australian Chemical Institute and a member of the Australasian Pharmaceutical Science Association. Nial is science director of the medicinal cannabis company Canngea Pty Ltd, a board member of the Australian Medicinal Cannabis Association, and a Standards Australia committee member for sunscreen agents.</span></em></p><p class="fine-print"><em><span>Elise Schubert is funded by a scholarship from the University of Sydney and Canngea Pty Ltd. </span></em></p>COVID-19 has resulted in higher than normal levels of medicine shortages. Here’s what to do if your local pharmacy is out of stock.Nial Wheate, Associate Professor of the Sydney Pharmacy School, University of SydneyElise Schubert, Pharmacist and PhD Candidate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1415232020-06-30T19:10:38Z2020-06-30T19:10:38ZThe updated deal for pharmacists will help recognise their role as health experts, not just retailers<p>Australia’s <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/New-7th-Community-Pharmacy-Agreement">7th Community Pharmacy Agreement</a>, which comes into force today and lasts five years, will see the government provide A$16 billion for dispensing subsidised medicines and A$1.15 billion for other services such as diabetes support.</p>
<p>The agreement was struck between the federal government, industry peak body the Pharmacists’ Guild and, for the first time, the <a href="https://www.psa.org.au">Pharmaceutical Society of Australia</a>, which represents Australia’s <a href="https://www.pharmacyboard.gov.au/About/Statistics.aspx">31,000 registered pharmacists</a>.</p>
<p>If you are a consumer, the new deal is a reassuring continuation of essential existing subsidies. Prescription medications accessed under the Pharmaceutical Benefits Scheme (<a href="https://www.pbs.gov.au/pbs/home;jsessionid=4jsuwyz06dyu1dhj761nqmhc5">PBS</a>) will still be available from your local chemist. There will be a bit more government support for some other services provided by pharmacies, especially to Indigenous people. There is continuing recognition of the need to locate a community pharmacy within reach of most people. </p>
<p>If you are a pharmacist, the agreement finally gives you a little recognition as a professional with years of training and high standards, as distinct from corporations with chains of chemist stores.</p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-the-community-pharmacy-agreement-38789">Explainer: what is the Community Pharmacy Agreement?</a>
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<h2>What’s in the agreement?</h2>
<p>The <a href="https://theconversation.com/explainer-what-is-the-community-pharmacy-agreement-38789">Community Pharmacy Agreement</a> is one of the building blocks of the Australian health system, which is notably fairer and more effective than that in the United States. The underpinning expectation is that the federal government will <a href="https://theconversation.com/explainer-how-is-the-price-of-medicine-decided-in-australia-83633">subsidise</a> prescription medicines under the PBS. We all benefit if everyone can afford those treatments. </p>
<p>Markets are imperfect. In an <a href="https://theconversation.com/relaxing-pharmacy-ownership-rules-could-result-in-more-chemist-chains-and-poorer-care-122628">unregulated</a> environment we would see pharmacies clustering in areas of high population – just like fast food shops – and not serving other areas such as outer suburbs and rural Australia.</p>
<p>The succession of Community Pharmacy Agreements, authorised under the <a href="https://austlii.edu.au/cgi-bin/viewdb/au/legis/cth/consol_act/nha1953147/">National Health Act</a>, uses regulation to avert this kind of market failure. The rules mean you cannot set up a pharmacy to compete with another nearby pharmacy, apart from under exceptional circumstances, thus ensuring the commercial viability of each pharmacy.</p>
<h2>Where’s the community?</h2>
<p>The “community” label is sometimes misunderstood. It doesn’t mean your local chemist is run by volunteers, the local council, or the federal government. Instead, it means the pharmacy operates on a commercial basis for people in the community. It is distinct from dispensing of medications by hospitals, which typically restrict what they offer to current patients and have a different business model.</p>
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<img alt="" src="https://images.theconversation.com/files/344695/original/file-20200630-103661-15ynk9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/344695/original/file-20200630-103661-15ynk9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/344695/original/file-20200630-103661-15ynk9w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/344695/original/file-20200630-103661-15ynk9w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/344695/original/file-20200630-103661-15ynk9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/344695/original/file-20200630-103661-15ynk9w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/344695/original/file-20200630-103661-15ynk9w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Pharmacies are a vital part of the community.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Elliston_Pharmacy,_2017_(01).jpg">Bahnfrend/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>Each pharmacy serving the community must be supervised by a pharmacist – a health practitioner who has undergone extensive training and meets the relevant professional criteria. Pharmacists are supervised under the <a href="https://www.ahpra.gov.au/About-AHPRA/What-We-Do/Legislation.aspx">National Health Practitioner Regulation Law</a> and associated <a href="https://www.pharmacyboard.gov.au">Pharmacy Board</a>.</p>
<p>The dispensing of medicine in community pharmacies needs to be supervised by pharmacists, although pharmacies can be owned by non-practitioners. The ongoing shift to corporate ownership is contentious, as pharmacies move away from being analagous to the “friendly family doctor” and towards a business model that emphasises selling jelly beans, “wellness” products and fluffy toys alongside medications. That model is not good for public health, and not necessarily good for the pharmacists themselves (more on this point later).</p>
<h2>What’s the significance of the new agreement?</h2>
<p>The agreement is important for three reasons. </p>
<p>First, and most importantly, it retains existing arrangements regarding distribution of pharmacies. Those arrangements have been criticised by entrepreneurs, often represented by the <a href="https://www.guild.org.au/news-events/news/2020/the-seventh-community-pharmacy-agreement">Pharmacy Guild</a>, which is the equivalent of industry peak bodies such as the Minerals Council of Australia.</p>
<p>The latest version of the agreement provides for updating of government payments to wholesalers and retailers of prescription medications – in other words, continued subsidisation of products under the PBS and support for the pharmaceutical supply chain. </p>
<p>There is little point in subsidising payments by consumers if there are no supplies in the warehouses for distribution to the pharmacies. That is an issue of concern amid a pandemic. Streamlining of processes under the agreement will make it easier for pharmacies to receive payments to dispense medicines subsidised under the PBS and the <a href="https://www.dva.gov.au/health-and-treatment/help-cover-healthcare-costs/manage-medicine-and-keep-costs-down/concessional">Repatriation Pharmaceutical Benefits Scheme</a>, which helps Australia’s veterans and predates the wider PBS.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/pay-pharmacists-to-improve-our-health-not-just-supply-medicines-124641">Pay pharmacists to improve our health, not just supply medicines</a>
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<p>There will be support for pharmacy services in regional, rural and remote areas, although past <a href="https://ajp.com.au/news/community-pharmacies-in-rural-and-remote-australia-are-on-the-brink-of-extinction/">concerns</a> about the viability of pharmacies in the bush mean it is uncertain whether this support will be sufficient.</p>
<p>Second, the agreement also provides support – mainly in the form of payments under the <a href="https://www.ndss.com.au/">National Diabetes Services Scheme</a> and the <a href="https://www1.health.gov.au/internet/publications/publishing.nsf/Content/nmp-guide-medmgt-jul06-contents%7Enmp-guide-medmgt-jul06-guidepr3">Dose Administration Aids</a> program – for advice by pharmacists regarding ongoing testing by consumers with diabetes and assistance to seniors. </p>
<p>There is also increased funding of programs aimed at boosting Aboriginal and Torres Strait Islander peoples’ access to medicines. </p>
<p>Finally, the agreement belatedly and weakly acknowledges the Pharmaceutical Society of Australia.</p>
<p>The society’s involvement in the agreement is important because health services are not just about profit. Corporate imperatives to maximise the use of floor space by selling <a href="https://theconversation.com/government-decision-not-to-ban-homeopathy-sales-from-pharmacies-is-a-mistake-96114">non-therapeutic</a> products are potentially at odds with both professional practice and consumer benefit. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pharmacists-should-drop-products-that-arent-backed-by-evidence-12646">Pharmacists should drop products that aren't backed by evidence</a>
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<p>The latest agreement expands the existing remuneration to pharmacy owners for pharmacists to provide health advice. This is likely to be a useful supplement, rather than a major revenue source. In the coming years we can expect to see claims by health economists and calls for greater support.</p>
<p>The Pharmaceutical Society’s involvement is more broadly relevant because the latest agreement provides for remuneration of advising by professionals. Community pharmacists are a first port of call for many people with health issues. Problems with the interaction of multiple medications mean we need accessible professional expertise. </p>
<p>Rewarding such service to the community means pharmacists, self-employed or otherwise, can concentrate on health, not jellybeans and complementary products.</p><img src="https://counter.theconversation.com/content/141523/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Baer Arnold does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The new Community Pharmacy Agreement will make it easier for Australia’s pharmacists to spend time providing expert health advice to customers rather than focusing on retail revenues.Bruce Baer Arnold, Assistant Professor, School of Law, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1239622020-04-21T12:47:47Z2020-04-21T12:47:47ZPharmacists could be front-line fighters in battle against opioid epidemic<figure><img src="https://images.theconversation.com/files/315053/original/file-20200212-61929-1m6slzs.jpg?ixlib=rb-1.1.0&rect=48%2C24%2C5400%2C3564&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">On average, more than 130 Americans die from an opioid overdose every day.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/19331187675272/">AP Photo/Keith Srakocic</a></span></figcaption></figure><p>When you stop at your local pharmacy to pick up a toothbrush or an antacid, soon you may also be able to buy an over-the-counter drug to reverse an opioid overdose. The lifesaving drug, naloxone, currently requires a prescription, but it may become available as an over-the-counter purchase in 2020. </p>
<p>Despite the <a href="https://www.cdc.gov/vitalsigns/opioids/index.html">national decrease in opioid prescriptions</a> since 2012, the <a href="https://www.cdc.gov/drugoverdose/data/prescribing.html">opioid crisis</a> continues. Access to prescription opioids have decreased due to <a href="https://doi.org/10.1111/add.14394">stricter legislation</a>, insurance regulations and the Centers for Disease Control Guideline for Prescribing Opioids for Chronic Pain. At the same time, the use of heroin and illegally manufactured synthetic opioids, such as fentanyl and counterfeit prescription opioids, has <a href="https://www.cdc.gov/nchs/data/databriefs/db356-h.pdf">escalated</a>. </p>
<p>In addition, <a href="https://doi.org/10.1001/jama.2018.2844">nearly 80% of opioid overdoses</a> involve multiple substances, compounding the risk of a fatal overdose. This reinforces the need for widespread, convenient naloxone access accompanied by <a href="https://doi.org/10.1097/ADM.0000000000000223">training on how to administer</a> this reversal drug. </p>
<p>As a <a href="https://cphs.wayne.edu/profile/ai6726">professor of pharmacy</a> and pharmacist, I believe that many more pharmacists can be engaged in providing naloxone for their patients.</p>
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<img alt="" src="https://images.theconversation.com/files/308474/original/file-20200103-11900-49bqho.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/308474/original/file-20200103-11900-49bqho.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/308474/original/file-20200103-11900-49bqho.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/308474/original/file-20200103-11900-49bqho.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/308474/original/file-20200103-11900-49bqho.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/308474/original/file-20200103-11900-49bqho.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/308474/original/file-20200103-11900-49bqho.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Communities demand attention for the damage caused by the opioid crisis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/new-york-nyusa-0831-overdose-awareness-1168887157">Shutterstock.com/SCOOTERCASTER</a></span>
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<h2>Essential medication to save a life</h2>
<p>An opioid overdose can depress a person’s respiratory center to the point where breathing stops, resulting in death. Naloxone can reverse this effect within minutes. With minimal training, anyone can safely administer naloxone in various forms – nasal spray, auto-injector or intramuscular injection – to effectively buy more time and get medical help for someone who has overdosed. </p>
<p>Naloxone has been used in hospitals for more than 40 years to reverse excess sleepiness and respiratory depression from opioid anesthesia and pain medication or to treat overdoses in the emergency room. During the 1990s, naloxone use expanded <a href="https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio">into communities</a> to first responders, laypersons and, most importantly, to people who use drugs to reverse opioid overdoses. </p>
<p>The U.S. surgeon general issued an <a href="https://www.surgeongeneral.gov/priorities/opioid-overdose-prevention/naloxone-advisory.html">advisory</a> in April 2018 encouraging family, friends and individuals at risk for an opioid overdose to carry naloxone and be trained to administer it. <a href="http://doi.org/10.1001/jamainternmed.2019.0272">Research shows</a> that wider access to naloxone is associated with fewer deaths. Naloxone could <a href="https://doi.org/10.1186/s12954-019-0352-0">successfully reverse</a> every witnessed opioid overdose, but only if naloxone is in the hands of a trained bystander. The challenge has been how to get naloxone to the people who need it.</p>
<p>In 48 states and the District of Columbia, pharmacists are now able to dispense naloxone under a standing order that does not require a physician’s prescription, or they can <a href="https://ldi.upenn.edu/brief/expanding-access-naloxone-review-distribution-strategies">directly prescribe naloxone</a>. But people may still be hesitant to ask for naloxone.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/308476/original/file-20200103-11896-6y7ecx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/308476/original/file-20200103-11896-6y7ecx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/308476/original/file-20200103-11896-6y7ecx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/308476/original/file-20200103-11896-6y7ecx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/308476/original/file-20200103-11896-6y7ecx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/308476/original/file-20200103-11896-6y7ecx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/308476/original/file-20200103-11896-6y7ecx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Pharmacies may one day dispense naloxone as an over-the-counter drug.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/naloxone-medicine-used-block-effects-opioids-1591052014">PureRadiancePhoto/Shutterstock.com</a></span>
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<h2>Why community pharmacists are key</h2>
<p><a href="https://www.psychiatry.org/patients-families/addiction/opioid-use-disorder/opioid-use-disorder">Opioid use disorder</a> is a chronic, relapsing, lifelong condition. Managing opioid use disorder requires sustained treatment and support, similar to other chronic conditions, such as diabetes and heart disease. But opioid use disorder often carries a social stigma, which can make people hesitant about seeking help through traditional health care channels. </p>
<p>People may be afraid to request a prescription for naloxone because they may be accused of misusing drugs. Others may not know how or where to obtain naloxone, particularly if they don’t have a regular health care provider. People who use drugs report <a href="https://doi.org/10.1007/s11606-015-3394-3">feeling stigmatized</a>, while <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082708/">providers including pharmacists may be uncomfortable</a> starting a conversation with patients about the importance of carrying naloxone. </p>
<p>Yet the greater the access to naloxone, the more likely this lifesaving drug will be administered to reverse an overdose. I believe that pharmacists in the community are ideally positioned as a local resource to obtain naloxone. Community pharmacies have evolved into <a href="https://www.michiganpharmacists.org/Portals/0/patients/communitypharmacy.pdf">neighborhood health centers</a> where individuals can access a variety of services outside a traditional clinical setting including immunizations, health screenings and lab monitoring. </p>
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<a href="https://images.theconversation.com/files/308472/original/file-20200103-11909-19koiog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/308472/original/file-20200103-11909-19koiog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/308472/original/file-20200103-11909-19koiog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/308472/original/file-20200103-11909-19koiog.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/308472/original/file-20200103-11909-19koiog.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/308472/original/file-20200103-11909-19koiog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/308472/original/file-20200103-11909-19koiog.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/308472/original/file-20200103-11909-19koiog.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Vial of naloxone.</span>
<span class="attribution"><a class="source" href="http://www.Shutterstock.com/418417357">PureRadiancePhoto/Shutterstock.com</a></span>
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<p><a href="https://doi.org/10.1097/ADM.0000000000000223">Pharmacists</a> can recommend and provide naloxone, opioid education and overdose prevention information to high-risk individuals and their support network. Pharmacists can make their pharmacy a safe and nonjudgmental resource, where people obtain and learn to administer naloxone, seek self-care advice and reduce harm from drug use, including clean needles and syringes. And pharmacists are well positioned to provide connections to local programs for recovery and support. They can make referrals to supportive health care providers and provide “whole person” care for vulnerable individuals. </p>
<h2>Federal support to halt deadly overdoses</h2>
<p>The U.S. Department of Health and Human Services recognizes the importance of addressing opioid use disorder and the opioid crisis with a <a href="https://www.hhs.gov/opioids/about-the-epidemic/hhs-response/index.html">5-point strategy</a>. This includes better access to opioid use disorder treatment, research funding, improved pain management and expanded naloxone availability in health care and community settings. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/325856/original/file-20200406-96658-1qy7sdo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/325856/original/file-20200406-96658-1qy7sdo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/325856/original/file-20200406-96658-1qy7sdo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=365&fit=crop&dpr=1 600w, https://images.theconversation.com/files/325856/original/file-20200406-96658-1qy7sdo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=365&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/325856/original/file-20200406-96658-1qy7sdo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=365&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/325856/original/file-20200406-96658-1qy7sdo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=459&fit=crop&dpr=1 754w, https://images.theconversation.com/files/325856/original/file-20200406-96658-1qy7sdo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=459&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/325856/original/file-20200406-96658-1qy7sdo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=459&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Emergency overdose kit.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Drug-Abuse-Treatment/3c546feaea4d4b1a827a397a9aece342/115/0">AP Photo/Jim Cole</a></span>
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<p>While naloxone is not yet available for purchase over the counter, the U.S. Food and Drug Administration supports this simple access and has developed a “drug facts naloxone label” with pictures making it easy for anyone to effectively administer the correct dose. Manufacturers can apply for over-the-counter status, and naloxone is expected to become available as an over-the-counter drug <a href="https://doi.org/10.1111/1475-6773.13125">this year</a>. The availability to purchase naloxone without a prescription and over the counter can remove the perceived stigma of having to request it from a health care provider or pharmacist. </p>
<p>Naloxone alone will not mitigate the opioid crisis. Yet the ability to reverse a fatal overdose – having someone nearby who carries and can administer naloxone – allows the survivor another chance to enter <a href="https://doi.org/10.2105/AJPH.2017.304187">treatment that addresses</a> the social, structural, genetic, behavioral and individual factors of opioid use disorder. Pharmacists have an important role in helping to remove the stigma associated with requesting and carrying naloxone by openly discussing its benefits and making naloxone available to all patients. </p>
<p>[<em>Insight, in your inbox each day.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=insight">You can get it with The Conversation’s email newsletter</a>.]</p><img src="https://counter.theconversation.com/content/123962/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Victoria Tutag Lehr has received funding from MDHHS, BCBSMF, Amerisource-Bergen.
</span></em></p>Pharmacists are well positioned to provide communities with a lifesaving drug.Victoria Tutag Lehr, Professor of Pharmacy, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1342312020-03-23T02:45:28Z2020-03-23T02:45:28ZCoronavirus: how to access the medicines you and your family need<figure><img src="https://images.theconversation.com/files/321867/original/file-20200320-22636-1swirpn.jpg?ixlib=rb-1.1.0&rect=0%2C4%2C998%2C652&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmacist-holding-medicine-box-capsule-pack-743384119">Shutterstock</a></span></figcaption></figure><p>Panic buying of toilet paper, no meat or soap on <a href="https://www.abc.net.au/news/2020-03-16/coronavirus-shopping-strips-supermarket-shelves-bare/12057924">supermarket shelves</a>, and now an <a href="https://www.theguardian.com/world/2020/mar/12/massive-shortages-rural-pharmacies-low-on-essential-medications-amid-coronavirus-crisis">apparent run</a> on medicines such as asthma puffers and children’s paracetamol. </p>
<p>The COVID-19 pandemic is affecting us in ways we’ve never had to deal with before. So Australia <a href="https://www.health.gov.au/news/deputy-chief-medical-officers-press-conference-about-covid-19-0">has announced</a> measures to help people access their medicines.</p>
<p>These include limiting the number of medications people can buy, dispensing only a month’s worth of supply at a time, and placing some behind the counter.</p>
<p>And, of course, pharmacies are essential services so they <a href="https://theconversation.com/nsw-and-victoria-announce-shutdowns-as-federal-government-widens-and-ramps-up-income-support-134355">will remain open</a> during the forthcoming shutdown period. </p>
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Read more:
<a href="https://theconversation.com/can-coronavirus-spread-through-food-can-anti-inflammatories-like-ibuprofen-make-it-worse-coronavirus-claims-checked-by-experts-133911">Can coronavirus spread through food? Can anti-inflammatories like ibuprofen make it worse? Coronavirus claims checked by experts</a>
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<p>There are also ways people who are self-isolating or at risk can access their medicines, from using apps, to government-funded free home delivery.</p>
<p>Here are some of your options for the weeks and months ahead.</p>
<h2>Purchase limits on essential medicines</h2>
<p>There are now <a href="https://www.health.gov.au/news/deputy-chief-medical-officers-press-conference-about-covid-19-0">purchase limits</a> on certain medicines.</p>
<p>Customers in pharmacies are <a href="https://www.tga.gov.au/media-release/limits-dispensing-and-sales-prescription-and-over-counter-medicines">now limited</a> to one of the following per person (or one month’s supply, if relevant):</p>
<ul>
<li><p>asthma puffers (Ventolin) and other medicines used for the treatment of chronic obstructive pulmonary disease (COPD)</p></li>
<li><p>paracetamol</p></li>
<li><p>Epipen, to manage severe allergic reactions</p></li>
<li><p>some heart medicines, such as glyceryl trinitrate</p></li>
<li><p>some diabetes medicines, including insulin</p></li>
<li><p>some anti-epileptic medicines.</p></li>
</ul>
<p>Purchasing limits have also been placed on many other prescriptions. </p>
<p>Pharmacists have been directed to only dispense <a href="https://www.tga.gov.au/media-release/limits-dispensing-and-sales-prescription-and-over-counter-medicines">one month’s supply</a> for more than 50 different medicines used to treat a range of conditions, including: cancer, Parkinson’s, chronic pain, blood pressure, and contraceptives. </p>
<p>Children’s paracetamol will now be kept <a href="https://ajp.com.au/news/new-dispensing-limits-imposed/">behind the counter</a>.</p>
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Read more:
<a href="https://theconversation.com/ibuprofen-and-covid-19-symptoms-heres-what-you-need-to-know-134064">Ibuprofen and COVID-19 symptoms – here's what you need to know</a>
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<h2>What to do if you can’t get to your local pharmacy</h2>
<p>If you have been directed to self-isolate or if it’s risky for you to shop at a pharmacy, there are still options.</p>
<p>If you are in isolation, are over the age of 70, of Aboriginal or Torres Strait Islander descent, or have a compromised immune systems or chronic health condition, <a href="https://www.ppaonline.com.au/programs/covid-19-home-medicine-service">you may be eligible</a> for a free service to deliver medicines to your home.</p>
<p>This scheme only covers the costs of delivery for <a href="http://www.pbs.gov.au/pbs/home">Pharmaceutical Benefits Scheme (PBS)</a> medicines. The scheme does not include everyday products like hand sanitiser or regular over-the-counter medicines.</p>
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Read more:
<a href="https://theconversation.com/why-are-older-people-more-at-risk-of-coronavirus-133770">Why are older people more at risk of coronavirus?</a>
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<p>If you’re not eligible for the home medicines service, one way to get your prescription and non-prescription medicines delivered to your home is via an app like <a href="https://mymedkit.com.au/app">mymedkit</a>. </p>
<p>This Australian-based company allows you to take a photo of your prescription and upload it into the app, where the script is then filled by your local pharmacy. </p>
<p>You can choose what day and time you want it delivered so you can be there when it arrives. And if you don’t need prescription medicines, they can also deliver other products like vitamins, skincare creams, first aid kits, baby wipes and nappies.</p>
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Read more:
<a href="https://theconversation.com/instant-prescriptions-might-be-the-way-of-our-digital-future-but-we-need-to-manage-the-risks-first-131308">Instant prescriptions might be the way of our digital future, but we need to manage the risks first</a>
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<img src="https://counter.theconversation.com/content/134231/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is Fellow of the Royal Australian Chemical Institute and a member of the Australasian Pharmaceutical Science Association. Nial is also a director of the medicinal cannabis company Canngea Pty Ltd and a Standards Australia committee member for sunscreen agents.</span></em></p><p class="fine-print"><em><span>Andrew Bartlett is an associate lecturer in Pharmacy practice at the University of Sydney and a member of the Australian College of Pharmacists.</span></em></p>Pharmacies are essential services and will remain open, but some people will still have problems accessing medicines. Here’s what you can do.Nial Wheate, Associate Professor | Program Director, Undergraduate Pharmacy, University of SydneyAndrew Bartlett, Associate Lecturer Pharmacy Practice, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1295612020-02-17T13:09:03Z2020-02-17T13:09:03ZWhat I’ve learnt about drug testing in Nigeria over the last 20 years<figure><img src="https://images.theconversation.com/files/314955/original/file-20200212-61974-ml9b98.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The government must harness analytical technologies developed by pharmaceutical scientists in Nigeria </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/auto-sampler-louder-high-technology-plasma-optical-royalty-free-image/1139063660?adppopup=true&uiloc=thumbnail_similar_images_adp">Sebastian Condrea/GettyImages</a></span></figcaption></figure><p>Poor quality medicine is one of the obstacles to improving health in developing countries. <a href="https://www.who.int/en/news-room/fact-sheets/detail/substandard-and-falsified-medical-products">One in 10 medicines</a> may not meet acceptable standards, according to the World Health Organisation (WHO).</p>
<p>The problem is prevalent on the African continent. The WHO received 1500 reports of poor quality and falsified medicines between 2013 and 2017: <a href="https://www.who.int/news-room/detail/28-11-2017-1-in-10-medical-products-in-developing-countries-is-substandard-or-falsified">42%</a> came from Africa. The London School of Hygiene and Tropical Medicine estimates that <a href="https://www.who.int/news-room/detail/28-11-2017-1-in-10-medical-products-in-developing-countries-is-substandard-or-falsified">116 000 additional deaths</a> could be caused every year by substandard and falsified antimalarial medicine in sub-Saharan Africa.</p>
<p>Nigeria’s experience over the past 10 years shows that cost-effective solutions to the problem of sub-standard drugs can be developed on the continent. But unless the government, academia, and the private sector collaborate, these solutions can end up not being used.</p>
<h2>The problem</h2>
<p>I was a postgraduate student of pharmaceutical chemistry in Nigeria in the early 1990s. I saw how difficult it was for local manufacturers and universities to maintain the analytical instruments needed to ensure drug quality. Most of the equipment was imported and expensive, and budgets were small. </p>
<p>Problems like this give counterfeiters and clandestine manufacturers a chance to push poor quality medicines into circulation.</p>
<p>This can be a <a href="https://medswecantrust.org/">setback</a> for the treatment of infectious diseases like tuberculosis, HIV/AIDS and malaria. It also contributes to the global problem of antibiotic resistance. Proper <a href="https://qualitymatters.usp.org/safe-quality-medicines-campaign-launch">quality</a> is important for patient safety as well as the effectiveness of medicine.</p>
<p>Several countries and regions have <a href="https://www.who.int/medicines/areas/quality_safety/quality_assurance/resources/qas_worldpharmmeetings/en/">pharmacopoeias</a> to guide drug quality <a href="https://www.usp.org/reference-standards">standards</a>. Most African countries don’t have pharmacopoeias. Developed countries fill the gap.</p>
<p>For example, the <a href="https://www.usp.org/">United States Pharmacopoeia</a>, funded by the United States Agency for International Development, has introduced a quality <a href="https://www.usp.org/global-public-health/promoting-quality-of-medicines">initiative</a> in several countries, Nigeria among them. The aim is to share scientific expertise and provide technical support. But these standards call for expensive technology. In most cases this has to be imported from Western countries. </p>
<p>There have been initiatives in Nigeria to develop local technology. But in my experience these initiatives fail to get traction. </p>
<h2>The learning journey</h2>
<p>A group of researchers at the pharmaceutical chemistry department of the University of Ibadan has looked into this issue. We came up with a <a href="https://www.ncbi.nlm.nih.gov/pubmed/16152928">method</a> for testing drugs using low-cost technology in 1998. </p>
<p>It started with the realisation that most modern drugs are aromatic in their chemical structure. They are also capable of absorbing ultraviolet light. The main drawback was that most drugs are colourless and are not directly measurable on digital colorimeters. These were much cheaper to maintain than Ultraviolet-visible spectrophotometers that are driven by monochromators. This was solved by chromophoric labelling – chemistry that imparts colour to a molecule. </p>
<p>The <a href="http://ir.library.ui.edu.ng/handle/123456789/2394">result</a> was a reagent and assay technology that fused low cost with high tech and versatility of applications. For example, it can be used to test the anti-inflammatory drug <a href="https://www.ncbi.nlm.nih.gov/pubmed/16751126">diclofenac</a>. Another example is a test for the blood pressure medication <a href="https://www.ncbi.nlm.nih.gov/pubmed/15287653">propranolol</a>.</p>
<p>Painfully, the technology was not adopted widely. This was mainly because there was no interface between the university and industry. Industry was not aware of the technology. What’s more frustrating is that the analytical reagent we developed has been used in other academic laboratories around the world.</p>
<p>A major lesson from our experience is that deliberate collaboration between industry, academia and government is the only way to maximise expertise and intellectual property of the Nigerian academy.</p>
<p>There are a myriad of examples of low-cost and agile technologies being used globally. For example, the WHO has designed tests and kits for use outside laboratories, such as in airports and at land borders. Also, the Global Pharma Health Fund in Germany has developed a <a href="https://www.gphf.org/en/minilab/">“mobile laboratory”</a>. This fits into a suitcase. It has been used, for example, to detect <a href="https://www.who.int/medicines/publications/drugalerts/drug_alert2-2017/en/">fake quinine</a> tablets in circulation in the Democratic Republic of Congo and <a href="https://www.who.int/medicines/publications/drugalerts/drug_alert4-2017/en/">fake penicillin</a> in Cameroon. This low-cost toolkit has <a href="https://www.gphf.org/images/downloads/library/17_Petersen_EPN_Minilab_Network_Studie.pdf">showed</a> promising results.</p>
<p>The Nigerian regulator, the National Agency for Food and Drug Administration and Control, also uses the minilabs. It also uses Truscan, a hand-held instrument to analyse the quality of drugs in circulation. Mobile laboratories reduce the risk of poor-quality drugs reaching patients. </p>
<h2>Longer term solution</h2>
<p>A more lasting solution for resource-poor economies would be to strengthen the ability of local manufacturers to make medicines of acceptable and consistent quality. Many manufacturers aren’t aware that there are low-cost – yet reliable – alternatives to expensive chemical analysis instrumentation.</p>
<p>Nigeria’s pharmaceutical industry is a case in point. An array of alternative assay methods has been documented in the analytical literature for clinically useful drugs. What’s missing is a deliberate commitment and policy to develop Nigerian drug manufacturing. Nigeria’s Ministry of Health should be leading this. For their part, academia and industry need to be working more closely together.</p>
<p>The <a href="https://www.pulse.ng/news/local/60-of-drugs-imported-to-be-manufactured-locally-nafdac/m7bxbvt">goal</a> of the National Agency for Food and Drug Administration and Control is to increase local manufacturing of drugs from 30% to 60%. The administration is promoting a policy called <a href="https://www.nafdac.gov.ng/five-plus-five-year-validity-migration-to-local-production-03191/">five plus five-year validity</a>. This aims to encourage systematic migration to local production in Nigeria.</p>
<p>Collaboration between the administration, the pharmaceutical industry and academia could facilitate local manufacturers’ efforts. They could do this by harnessing the inexpensive and reliable analytical technologies developed by pharmaceutical scientists in Nigeria.</p><img src="https://counter.theconversation.com/content/129561/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sunday Olakunle Idowu does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There are cost-effective solutions to the problem of sub-standard drugs in Nigeria and other low-income countries.Sunday Olakunle Idowu, Professor of Pharmaceutical Chemistry (Pharmaceutical Profiling & Informatics), University of IbadanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1273152019-11-27T06:21:04Z2019-11-27T06:21:04ZWhat is the Pharmacy Guild of Australia and why does it wield so much power?<figure><img src="https://images.theconversation.com/files/303610/original/file-20191125-84213-nnbk8h.jpg?ixlib=rb-1.1.0&rect=0%2C13%2C4373%2C3258&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Pharmacy Guild of Australia was founded in 1928 as an employers' organisation for the owners of community pharmacies.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>Across Australia around <a href="https://www.guild.org.au/__data/assets/pdf_file/0026/83672/Guild_Fact_Sheet_September_October_Infographic_2019.pdf">5,700 community pharmacies</a> are responsible for dispensing the majority of prescriptions subsidised under the Pharmaceutical Benefits Scheme (PBS).</p>
<p>These community pharmacies are represented nationally by the <a href="https://www.guild.org.au/">Pharmacy Guild of Australia</a>.</p>
<p>Every five years the Australian government consults with the Pharmacy Guild before delivering the Community Pharmacy Agreement. This agreement governs how pharmacies are reimbursed for dispensing medicines listed on the PBS, and the sorts of services you can access at the pharmacy.</p>
<p>The <a href="http://6cpa.com.au/about-6cpa/">6th Community Pharmacy Agreement</a> expires on June 30, 2020. Negotiations are currently underway for the 7th agreement, expected to cost some <a href="https://www.abc.net.au/radionational/programs/breakfast/convenience-stores-and-petrol-stations-push-to-sell-medicine/11407406">A$20 billion</a> over five years.</p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-the-community-pharmacy-agreement-38789">Explainer: what is the Community Pharmacy Agreement?</a>
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<p>The Pharmacy Guild is the major player involved in negotiating with the government how much money is spent through the Community Pharmacy Agreement, and where the money goes.</p>
<p>Given the funds at stake, and the importance of ensuring the availability of PBS medicines, it’s pertinent to look at what the Pharmacy Guild is and where its power comes from.</p>
<h2>Ensuring community pharmacies are sustainable</h2>
<p>The Pharmacy Guild of Australia was founded in 1928 as an employers’ organisation for the owners of community pharmacies. Pharmacy owners must be registered pharmacists, but the pharmacy profession is represented separately by the <a href="https://www.psa.org.au/">Pharmaceutical Society of Australia</a>.</p>
<p>The Pharmacy Guild’s key focus is the financial sustainability of community pharmacy. Over the years they’ve sought to protect pharmacists’ income generated from the PBS (between 41% and 46% of their <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/4E0B6EEE19F56A40CA2581470016D688/%24File/pharmacy-financial-survey-research-report.pdf">total income</a>, depending on location). </p>
<p>This is highlighted, for example, by the <a href="http://www.apha.org.au/wp-content/uploads/2012/11/You-Cant-Cut-Corners-with-Chemotherapy-an-overview.pdf">2013 fight</a> over dispensing fees for cancer drugs. The Pharmacy Guild was able to recoup <a href="https://archive.budget.gov.au/2013-14/myefo/2013_14_MYEFO.pdf">A$82.2 million</a> to increase dispensing fees for chemotherapy drugs, after <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/chemotherapy-review/$File/29%20-%20Pharmacy%20Guild%20of%20AustraliaSubmission%20July%202013.pdf">it protested</a> changes in funding arrangements for <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/chemotherapy-review/$File/review-of-chemotherapy-funding-arrangements.pdf">chemotherapy services</a> left pharmacies with a A$277 million shortfall.</p>
<p>Similarly, the Pharmacy Guild was able to coerce the government into providing <a href="https://www.ruralhealth.org.au/sites/default/files/documents/Minister_Hunt_DoH_Budget_17-18_lock-up_presentation.pdf">A$210 million</a> in the 2017-18 budget to community pharmacies as compensation for lower than forecast prescription volumes.</p>
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<img alt="" src="https://images.theconversation.com/files/303611/original/file-20191126-84231-i8j2ij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/303611/original/file-20191126-84231-i8j2ij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/303611/original/file-20191126-84231-i8j2ij.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/303611/original/file-20191126-84231-i8j2ij.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/303611/original/file-20191126-84231-i8j2ij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/303611/original/file-20191126-84231-i8j2ij.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/303611/original/file-20191126-84231-i8j2ij.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Negotiations for the 7th Community Pharmacy Agreement are currently underway.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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<p>Further, the Pharmacy Guild has <a href="https://www.afr.com/opinion/turnbull-government-backs-pharmacies-over-consumers-yet-again-20180508-h0zryn">fiercely and successfully opposed</a> efforts to change the <a href="https://www.guild.org.au/news-events/news/2019/pharmacy-location-rules-delivering-public-benefit-for-decades">location rules</a> which govern the clustering of pharmacies, to allow pharmacies in supermarkets, and other efforts to <a href="https://www.bankwest.com.au/content/dam/bankwest/documents/business/insights/focus-on-pharmacy-report-2019.pdf">increase competition</a>. </p>
<p>The guild has also pushed for pharmacies to receive funding to deliver primary care services to patients. Both the Pharmacy Guild and the Pharmaceutical Society of Australia regard the community pharmacy sector as <a href="https://www.guild.org.au/__data/assets/pdf_file/0026/4769/here-.pdf">an ideal environment</a> to host preventative health initiatives, such as immunisations and screening services.</p>
<p>Under the 6th Community Pharmacy Agreement, funding for these sorts of services has exceeded <a href="http://www.pbs.gov.au/info/general/sixth-cpa-pages/community-pharmacy-programmes">A$1.26 billion</a>. It’s highly likely funding for these activities will be increased in the next Community Pharmacy Agreement.</p>
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<strong>
Read more:
<a href="https://theconversation.com/pay-pharmacists-to-improve-our-health-not-just-supply-medicines-124641">Pay pharmacists to improve our health, not just supply medicines</a>
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<p>Despite the fact uptake of these programs is <a href="https://www.allfin-financial.com.au/australias-successful-pharmacies/">described</a> as “alarmingly low”, this has generated <a href="https://www.smh.com.au/politics/federal/doctors-raise-the-stakes-in-turf-war-with-pharmacists-20190826-p52ks5.html">turf fights</a> between doctors and pharmacists.</p>
<p>Some of the medical opposition is because <a href="https://www.guild.org.au/programs/6cpa">evaluations</a> of a number of long-running pharmacy programs have failed to demonstrate their value. In most cases, there has been insufficient data to enable any assessment of the impact of these programs on health outcomes.</p>
<h2>So why are they so powerful?</h2>
<p>The lobbying capabilities of the Pharmacy Guild executive and its members, the reach into every community, and the <a href="https://ajp.com.au/news/guild-boosts-parties-coffers/">substantial political donations</a> they make, mean politicians are always nervous about treading on community pharmacies’ toes.</p>
<p>Community pharmacies have a unique ability to garner public support for their causes from loyal customers. This can be a potent deterrent for any politician proposing changes the Pharmacy Guild views as adverse.</p>
<p>We saw this <a href="https://www.abc.net.au/news/2013-09-17/threat-to-the-survival-of-local-pharmacies-exaggerated/4948390">during the 2013 election campaign</a> when customers were petitioned to save their local pharmacies, supposedly under threat after a move by the Rudd government to reduce the price of prescription medicines.</p>
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<img alt="" src="https://images.theconversation.com/files/303890/original/file-20191127-112531-t7ggha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/303890/original/file-20191127-112531-t7ggha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/303890/original/file-20191127-112531-t7ggha.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/303890/original/file-20191127-112531-t7ggha.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/303890/original/file-20191127-112531-t7ggha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/303890/original/file-20191127-112531-t7ggha.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/303890/original/file-20191127-112531-t7ggha.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Community pharmacies are often able to cultivate loyal customers.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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<p>In terms of political donations, the Pharmacy Guild was ranked as <a href="https://ajp.com.au/news/guild-boosts-parties-coffers/">the 14th largest political donor</a> in 2017-18 (the latest period we have data for).</p>
<p>Their <a href="https://www.abc.net.au/news/2019-02-01/donations-australia-federal-politics-foreign/10768226">political contributions</a> in that financial year totalled A$220,000. More than half of this (A$139,500) went to the Labor Party, with the remainder going to the Liberal and National Parties.</p>
<p>Most recently a donation of <a href="https://junkee.com/pharmacy-guild-one-nation/200587">A$15,000 to One Nation</a> generated controversy.</p>
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<strong>
Read more:
<a href="https://theconversation.com/how-rivalries-between-doctors-and-pharmacists-turned-into-the-turf-war-we-see-today-122534">How rivalries between doctors and pharmacists turned into the 'turf war' we see today</a>
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<p>The Pharmacy Guild has been <a href="https://www.guild.org.au/news-events/news/forefront/v08n05/the-guild-and-the-political-process">open</a> about its ability to work within political processes, regardless of who is in government.</p>
<p>Its many critics, however, see the approach as one of manipulation. Former chair of the Australian Competition and Consumer Commission, Graeme Samuel, <a href="https://www.smh.com.au/politics/federal/discount-chemists-the-new-uber-former-accc-chief-backs-pharmacy-deregulation-20190814-p52gxz.html">has described</a> some of the guild’s tactics as “political blackmail”.</p>
<h2>Towards the 7th Community Pharmacy Agreement</h2>
<p>We don’t yet know what’s going to be contained in the 7th Community Pharmacy Agreement.</p>
<p>Regrettably, despite the large sums of money involved and the importance of community pharmacy as a public asset, there’s no transparency around the negotiations. </p>
<p>There’s also been little apparent consultation with other key stakeholders, particularly consumers. The Pharmacy Guild – and with it the interests of its members – appears, unsurprisingly, to be driving where health minister Greg Hunt will go with this agreement.</p>
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<strong>
Read more:
<a href="https://theconversation.com/relaxing-pharmacy-ownership-rules-could-result-in-more-chemist-chains-and-poorer-care-122628">Relaxing pharmacy ownership rules could result in more chemist chains and poorer care</a>
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<img src="https://counter.theconversation.com/content/127315/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lesley Russell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Pharmacy Guild represents the owners of community pharmacies around the country. Their reach into every community and large political donations make them more powerful than other lobby groups.Lesley Russell, Adjunct Associate Professor, Menzies Centre for Health Policy, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1246412019-10-10T04:53:39Z2019-10-10T04:53:39ZPay pharmacists to improve our health, not just supply medicines<figure><img src="https://images.theconversation.com/files/296159/original/file-20191009-3867-dvwfmu.jpg?ixlib=rb-1.1.0&rect=1%2C5%2C997%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pharmacists receive no financial incentive to counsel patients about how to take their medicines. That needs to change.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/experienced-pharmacist-counseling-female-customer-modern-530265058?src=VfnYpYXbVyVUTGL1OYG9QA-1-0">from www.shutterstock.com</a></span></figcaption></figure><p>When you have a medicine dispensed at your local pharmacy under the
<a href="http://www.pbs.gov.au/">Pharmaceutical Benefits Scheme</a> (PBS), two things happen. The federal government determines how much the pharmacy receives for dispensing your medicine. It also decides what you need to pay. </p>
<p>This so-called fee-for-service funding means pharmacies maximise their revenue if they dispense many prescriptions quickly.</p>
<p>Rather than fast dispensing, it would be better for patients and the health-care system if the funding model paid pharmacists for improving the use of medicines, not just for supplying them. </p>
<p>This is possible, according to our research <a href="https://www.publish.csiro.au/AH/AH18201">published recently</a> in the Australian Health Review. And it should be considered as part of the next <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/New-7th-Community-Pharmacy-Agreement">Community Pharmacy Agreement</a>, which outlines how community pharmacy is delivered over the next five years.</p>
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<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-the-community-pharmacy-agreement-38789">Explainer: what is the Community Pharmacy Agreement?</a>
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<h2>Dispensing medicine is more complex than it looks</h2>
<p>Dispensing medications may seem simple but this can be misleading: it includes both commercial and professional functions. </p>
<p>Under the PBS, the pharmacy receives a handling fee and mark-up on the cost of the drug to cover the commercial cost of maintaining the pharmacy and stock. </p>
<p>It also receives a dispensing fee for the pharmacist’s professional activities. These include reviewing the prescription to ensure it is legal and appropriate, taking into account factors such as your age, whether you are pregnant and which medicines you’ve been prescribed before; creating a record of the dispensing; labelling the medicine; and counselling you, including providing a medicine information leaflet if needed.</p>
<p>Higher dispensing fees are paid for medicines needing greater levels of security (such as controlled drugs including opioids) and for medicines the pharmacist must make up (such as antibiotics in liquid form).</p>
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<strong>
Read more:
<a href="https://theconversation.com/health-check-is-it-ok-to-chew-or-crush-your-medicine-39630">Health Check: is it OK to chew or crush your medicine?</a>
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<p>But for the vast majority of PBS prescriptions, a pharmacy receives the same basic dispensing fee, currently <a href="http://www.pbs.gov.au/info/healthpro/explanatory-notes/front/fee">A$7.39</a>.</p>
<p>If you have a medicine dispensed for the first time, if it has a complicated dose, or it carries particular risks such as side effects or interactions, a pharmacist is professionally obliged to provide counselling matched to the risk. The more detailed the counselling, the greater the time needed. </p>
<p>However, at present, the dispensing fee to the pharmacy does not change depending on the level of counselling you need. Indeed, the current funding model is a <em>disincentive</em> for the pharmacist to spend time with you explaining your medicine. That’s because the longer they spend counselling, the fewer prescriptions they can dispense, and the fewer dispensing fees they receive.</p>
<h2>What could we do better?</h2>
<p>Performance-based funding, in which payment is adjusted in recognition of the efforts of the service provider or the outcomes of the service delivered, is becoming <a href="https://www.sciencedirect.com/science/article/abs/pii/S0168851013000183">more common</a> in health care and <a href="http://www.euro.who.int/__data/assets/pdf_file/0020/271073/Paying-for-Performance-in-Health-Care.pdf">can correct</a> some of the volume-related issues mentioned above. </p>
<p>It’s already being used in Australia. For instance, GPs are paid a <a href="https://www.humanservices.gov.au/organisations/health-professionals/services/medicare/practice-incentives-program">Practice Incentives Program</a> (PIP) to encourage improvements in services in areas such as asthma and Indigenous health. </p>
<p>However, performance-based funding has yet to be used for pharmacists’ dispensing in Australia. </p>
<p>We propose dispensing fees should be linked to the effort pharmacists make to promote improved use of medicines. This is based on the principle that counselling means <a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2013.1398">people are more likely to take their medications</a> as prescribed, which improves their health. </p>
<p>In other words, pharmacists would receive higher dispensing fees when more counselling is required or if counselling leads to patients taking their medications as prescribed.</p>
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<a href="https://images.theconversation.com/files/296160/original/file-20191009-3894-nireuq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/296160/original/file-20191009-3894-nireuq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/296160/original/file-20191009-3894-nireuq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/296160/original/file-20191009-3894-nireuq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/296160/original/file-20191009-3894-nireuq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/296160/original/file-20191009-3894-nireuq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/296160/original/file-20191009-3894-nireuq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/296160/original/file-20191009-3894-nireuq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Pharmacists who spend longer counselling, for instance if someone’s health status has changed, should be rewarded for it.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/432551314?src=2-kqvJbHWH34nwt6dQsUpw-1-8&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>Dispensing fees could be linked to the actual time taken to dispense a prescription: the longer the time, the higher the fee. The time taken would depend on the nature of the drug; the complexity of the patient’s treatment; recent changes in the patient’s health status or other medicines that need to be taken into account; consultation with the prescribing doctor; and the level of advice and education provided. </p>
<p>A blended payment model could include a fee-for-service payment for commercial processes and a performance-linked payment for professional functions.</p>
<p>The most experience with performance-based payments to pharmacy <a href="https://www.ncbi.nlm.nih.gov/pubmed/28844583">is in the United States</a>, where evidence is developing of patients taking their medicine as prescribed and lower total health-care costs. </p>
<p>In England, the government’s <a href="https://www.england.nhs.uk/primary-care/pharmacy/pharmacy-quality-payments-scheme/pqs/">Pharmacy Quality Scheme</a> is similar to the Australian Practice Incentives Program for GPs. It funds improved performance in areas such as monitoring use of certain drugs and patient safety.</p>
<p>There is some <a href="https://ahha.asn.au/system/files/docs/publications/deeble_issues_brief_no_5_partel_k_can_we_improve_the_health_system_with_pay-for-performance.pdf">concern</a> about performance-linked payments. Performance targets need to be achievable without being onerous. And performance needs to be clearly linked to the payment being made, but not if other services suffer.</p>
<h2>Incentives could apply to you too</h2>
<p>Cost is a barrier to some people taking their medicines <a href="https://www.pc.gov.au/research/ongoing/report-on-government-services/2017/health/rogs-2017-volumee.pdf">with over 7%</a> of Australians delaying or not having prescriptions dispensed due to cost.</p>
<p>However, there is currently no financial incentive for you to have a <a href="https://www.healthdirect.gov.au/generic-medicines-vs-brand-name-medicines">generic</a> (non-branded) medicine dispensed, which would save on PBS expenditure. So it makes sense for generic medicines to be a lower cost to you.</p>
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<strong>
Read more:
<a href="https://theconversation.com/health-check-how-do-generic-medicines-compare-with-the-big-brands-42472">Health Check: how do generic medicines compare with the big brands?</a>
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<p>There is also currently no financial incentive for you to take your medicine as prescribed, which would likely improve your health and save the health budget in the long run. We are not aware of any country varying patient charges based upon this, although there are ways of monitoring if people take their medicines as directed.</p>
<p>However, countries such as New Zealand and the United Kingdom have lower or no patient prescription charges, minimising costs as a barrier to patients taking their medicine. </p>
<h2>What would need to happen?</h2>
<p>Dispensing a prescription should be an invitation for the pharmacist to interact with you and help you with advice on the effective and appropriate use of your medicine. At present, there is no incentive, other than professionalism, for pharmacists to add such value. </p>
<p>The proposed changes would require a major restructure to the funding of dispensing to provide incentives that are equitable and transparent and that did not adversely affect disadvantaged, rural and Indigenous people.</p>
<p>There would need to be agreement on <a href="https://ahha.asn.au/system/files/docs/publications/deeble_issues_brief_no_5_partel_k_can_we_improve_the_health_system_with_pay-for-performance.pdf">reliable and valid</a> performance measures and reliable information systems.</p>
<p>However, funding based on a professional service model rather than a dispensing volume model would support your pharmacist to provide greater benefit to you and the health-care system.</p><img src="https://counter.theconversation.com/content/124641/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Jackson is a Fellow of the Pharmaceutical Society of Australia and of the Society of Hospital Pharmacists of Australia and conducts research into pharmacy practice at Monash University Faculty of Pharmacy and Pharmaceutical Sciences.</span></em></p><p class="fine-print"><em><span>Ben Urick conducts research into performance-based pharmacy payment models at the University of North Carolina. He also consults with Pharmacy Quality Solutions, an IT vendor in the United States which supports performance-based community pharmacy payment models. Additionally, he is affiliated with the Pharmacy Quality Alliance, a medication-related quality measure developer, as a scientific advisor. </span></em></p>Pharmacies are paid a set amount to dispense most medicines, so the more they dispense, the greater their income. But there’s a better way to pay pharmacists and improve health care at the same time.John Jackson, Researcher, Faculty of Pharmacy and Pharmaceutical Sciences, Monash UniversityBen Urick, Research Assistant Professor, University of North Carolina at Chapel HillLicensed as Creative Commons – attribution, no derivatives.