Available now for public access through both AdPha and RACGP, the Resource Kit
comprises three resources to support clear, accurate and timely communication as
patients transition through care providers:

1. Practice Update: Medication Management at Transitions of Care clearly defines
the role of the hospital pharmacist, general practice pharmacist (GPP), and the
general practitioner (GP) in delivering safe and quality medication management
services to their patients transitioning between acute and primary care.

2. Resource for healthcare professionals: Safe Medication Management at
Transitions of Care supports healthcare professionals in ensuring safe and
effective medication management during patient transitions between care
settings.

3. Resources for consumers: Medication safety when moving between the
community and hospital helps consumers manage their medicines safely when
moving between home and hospital.

The Transitions of Care resources are now available at the following:
– Medication Management at Transitions of Care Resource Kit (AdPha)
– Medication Management at Transitions of Care Resource Kit (RACGP)

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Started by Dr Geoffrey Toogood in 2017, Crazy Socks for Docs Day aims to address mental health stigma among health practitioners.

It’s a day for doctors to recognise that it’s OK not the be OK and it’s more important now than ever.

The Covid-19 pandemic has made the past two years, particularly challenging for those on the frontline.

RACGP President Adjunct Professor Karen Price says that “burnout and mental health issues are real concerns” for the profession – health issues that have been exacerbated by the pandemic.

However, she says that mental health stigma remains an issue, making initiatives like Crazy Socks for Docs Day so important.

“It created a safe space for us to have a conversation about mental health and wellbeing and to fight the stigma, and we really need that,” says A0dj. Professor Price.

“I hope that this year we see more Australians getting behind this cause and joining doctors in wearing their ‘crazy socks’ on Friday 3 June – because mental health support for those who need it is so critical right now.

“I encourage everyone to check in with themselves, their colleagues and loved ones. And if you need help, reach out for support – this could be reaching out to your own GP, or a psychologist or psychiatrist.”

The RACGP is selling special socks, with all proceeds going to Beyond Blue. Show your support by purchasing your own pair online at the RACGP Shop, and wearing them on Friday 3 June.

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It comes following several changes to eligibility for Covid-19 vaccines and different criteria applying depending on where a person lives and how they will access a vaccine. Whilst Doctors understand the shared decision making necessary to tailor these messages, some patients appear to be confused regarding the regular change and updates. 

For example, in Western Australia, anyone over the age of 30 is eligible to receive a Pfizer vaccine, while anyone over the age of 16 can get that same vaccine in the Northern Territory and some rural areas of South Australia. In Greater Sydney, patients who have had their first dose of the AstraZeneca vaccine are now being encouraged to consider having their second dose at six weeks rather than 12 weeks.

In addition, the Government announced on 28 June this year that any Australian aged under 60 can receive the AstraZeneca vaccine after talking through their options with their GP. This is only applicable to Commonwealth sites such as general practices, not state-based vaccine hubs, creating even more confusion about where people can get their vaccine.

RACGP President Dr Karen Price says it is time for consistent messages from governments across Australia.

“The RACGP is calling on the federal, state, and territory governments to make it crystal clear who currently has access to which vaccine and where they can get them,” she says.

“Patients across Australia are suffering from ‘information overload’ and confused about their eligibility status and what next steps they should take. The goalposts seem to be shifting every other day and I am concerned that some patients will find it all too difficult and delay or avoid getting vaccinated altogether.

“Different states and territories might need different eligibility settings for perfectly good reasons to suit the local context and needs, such as what we are currently seeing in Greater Sydney. However, practices administering vaccines in locations where the state eligibility requirements differ from the federal eligibility requirements are shouldering an unnecessary burden.

“Many patients don’t realise that different rules apply to state government-run vaccine clinics and GP-run clinics, with general practices following federal rules because the Commonwealth is responsible for the rollout to general practice.

“Compounding this problem is the fact that GPs, nurses, receptionists and administrative staff are relying on updates from the Prime Minister, Premiers, Chief Ministers, Chief Health Officers and other public figures on their TV screens. Sometimes new information is being delivered in the middle of a working day when they are busy delivering vaccines to patients whose eligibility may be subject to change.

“Due to this, our hard-working general practice staff are spending valuable time comprehending and explaining the new rules. They are bearing the frustrations and sometimes aggressive behaviour from patients who don’t understand why they can get a particular jab at one place and not another.

“It is wasting time and causing unnecessary pain for practice teams at a time when they are busier than ever doing the job of rolling out Covid-19 vaccines as quickly as possible, while also continuing regular care for their patients.

“Governments need to work together through national cabinet to ensure that each jurisdiction’s eligibility criteria are clearly available to all vaccine providers and patients, and information needs to be updated immediately as changes occur and reach the people who need it.

Dr Price says there needs to be a national conversation regarding local vaccine eligibility criteria for new groups of people, particularly considering the Delta variant is spreading in New South Wales.

“The environment has changed the risk, and this can be communicated clearly,” she says.

“The federal Government should seek ATAGI advice regarding opening up vaccine eligibility to teachers, pregnant women and people living with healthcare workers, older people or Aboriginal and Torres Strait Islander people, who are currently not eligible to receive a Pfizer vaccine,” she says.

“Teachers work closely alongside children who are understandably ill-equipped to practice social distancing and are at times super-spreaders of this virus. As reported recently, health experts have said that pregnant women should be offered the Pfizer vaccine at any stage of their pregnancy. This is because the risk of severe outcomes from Covid-19 is significantly higher for pregnant women and their unborn baby.

“People living together in households are far more likely to spread the virus to each other, so it makes sense to expand access to people living with healthcare workers, other frontline workers and vulnerable groups who currently don’t qualify for a vaccine.

“It is true these people can potentially receive the AstraZeneca vaccine after a discussion with their GP but we are seeing that many Australians are reluctant to take up this option given the constantly changing advice on who should receive the vaccine has eroded patient confidence.

“AstraZeneca is a sound option when compared to the risks of the Covid-19 virus, especially for more vulnerable patients including older people.  The second dose in particular is essential to protect against severe hospitalisation, severe illness and death.

“However, making vaccines more available for at-risk groups that don’t currently fit within the current Pfizer eligibility criteria will help stop the spread of this virus when outbreaks occur. This should include not only general practices but the state-run vaccine hubs.”

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The cohort study published in PLOS Medicine showed that screening people for their genetic heart disease risk could help detect those likely to suffer a heart or stroke, allowing doctors to begin preventative treatment.

According to the researchers, targeted use of genetic screening could translate into meaningful clinical benefit if applied at scale and could lead to the prevention of 7% more cardiovascular events than conventional risk factors alone.

“Our results suggest that addition of polygenic risk scores to conventional risk factors can modestly enhance prediction of first-onset cardiovascular disease and could translate into population health benefits if used at scale,” conclude the researchers.

For more information and to read the study, visit: journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003498

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The Therapeutic Goods Administration (TGA) has announced that a vaccine should be approved by January ahead of a later rollout in March to priority groups. 

The Department of Health has said that pharmacists are part of the vaccination program for the broader population later in the year. 

As outlined in the policy, key vaccination sites for the vaccine priority groups are expected to initially include hospitals, respiratory clinics and general practices, says a Department of Health spokesperson.

“Pharmacists are expected to play a role in the wider COVID-19 vaccination rollout, occurring from mid-2021.”

However, doctor groups are opposed to this on the basis that pharmacies as retailers have the incentive to sell products. 

Their argument is that pharmacists are not capable of effectively dealing with complexities of the task such as adverse events, social distancing, post-vaccine observation, cold chain storage, multiple-dose vials and the need to enter all vaccinations on the national immunisation register.

The Pharmacy Guild of Australia is adamant that pharmacists should be permitted to administer the vaccine.

President of the Pharmacy Guild of Australia George Tambassis says that pharmacist participation will enable faster vaccination of the population, enable patient choice and that the profession is equipped to deal with the complexities of the task. 

Associate Professor Chris Freeman, chief executive of Pharmaceutical Society of Australia, told the Sydney Morning Herald it makes sense to include pharmacists as they are accessible healthcare professions across the country, with pharmacists having the necessary skills, capability and competency for the job. 

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Led by CQUni Nursing Senior Lecturer Dr Ashlyn Sahay and Exercise and Sports Sciences Lecturer Dr Samantha Fien, the study is looking beyond the emotional and psychological impact of the virus on health professionals and instead aims to focus on the psychosocial work environment, in a bid to improve their capacity to provide quality care.

“There is currently limited empirical evidence on the impact of Covid-19 on healthcare professionals” says Dr Sahay.

“Gaining this insight will develop our understanding of how we can strengthen the psychosocial work environment and identify areas of focus for effective leadership to support healthcare professionals and enhance their capacity to deliver quality care during times of crisis.”

Dr Sahay says online surveys of health professionals and clinicians from around Australia and the world, started last month, with the data still being collated, but the pressure on health services was already evident with tens of millions of Covid-19 cases and more than a million deaths worldwide.

“The Covid-19 pandemic has required health systems to change much faster than normal,” she says.

“While traditionally many practitioners have experience working over long periods in effective teams to deliver complex services, crisis situations such as the Covid-19 pandemic saw healthcare professionals quickly becoming part of new teams and having to perform to a high standard in a short time in a changed workplace dynamic.

“Moreover, healthcare professionals are often confronted with high demands in their daily working conditions.

“Besides high workload, staff shortage, and shift working, healthcare professionals have to deal with suffering and dying patients and their families, time pressure, perceived lack of reward, and sometimes conflict with other professions.

“Given the increased demand for healthcare services and especially during a pandemic, healthcare professionals carry both a physical as well as a continuous psychological burden, which can have an impact on quality of care.”

She says to date, emphasis on healthcare professionals and the psychosocial factors are not as closely explored and integrated in understanding the effect on the health workforce and provision of care during a crisis.

“It is well known that quality measurement is essential during both times of stability and times of crisis,” she says.

“During a crisis, healthcare is still being delivered, and the need to understand the quality and safety of that care becomes more important as the care processes continue to rapidly change.

“Earlier non Covid-19 studies indicate safety climates for healthcare professionals spill over into adverse outcomes for their health, and when these healthcare professionals are compromised, then so too is their provision of quality patient care.

“As such, the psychosocial workplace dynamics have traditionally presented challenges and complexities to healthcare professionals’ provision to deliver quality care, which potentially is now exacerbated by Covid-19 crisis.

“The current approach, therefore, is simply not resilient enough when attention and resources need to be focused holistically, with perspectives of frontline healthcare professionals integrated into the decision-making of a pandemic and crisis management for future unprecedented times.”

The survey component of the study is expected to be completed by the middle of 2021.

Healthcare professionals interested in participating in the study can contact Dr Sahay via email: a.sahay@cqu.edu.au.

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The introduction of electronic prescribing is a major change in the way patients access prescription medicines, and it is one that is supported by pharmacists and doctors.

The new system gives patients convenient access to their medicines and improves patient safety, with a reduction in the risk of errors that can be associated with written prescriptions.

There are two ways a patient can be given an electronic prescription.

The first is the token system which is based on an SMS message containing a QR code being sent to the patient’s smartphone. The patient then takes their smartphone to their preferred pharmacy and with the pharmacist’s guidance, the QR code is scanned and the pharmacist then downloads the individual prescription.

With this system, each prescription requires a different QR code and multiple SMS messages, so this system is best suited for patients who have an acute condition and don’t require multiple medications or prescriptions.

For those who have chronic conditions or need multiple medications, the other option for electronic prescriptions is called an Active Script List. The patient provides their consent to their GP or pharmacy with access to their list of prescriptions. The patient just needs to provide identity at their preferred pharmacy to access their prescriptions and medications.

It is anticipated that this will be available from November 2020.

The choice remains with the patient as to whether to use electronic prescriptions, and paper-based prescriptions will continue to be fully supported by GPs and pharmacists.

The National President of the Pharmacy Guild, George Tambassis, says the introduction of electronic prescribing is an important development.

“This new system provides ease of access for patients as well as enhanced safety.  Also once it is fully bedded-in it will cut administrative work for health professionals, freeing up time to devote to patient welfare.

“However, it is early days in the introduction of this system and it is very important that this change is orderly and carried out in a way that does not put patients at risk of missing their medicines because of confusion about the process.”

PSA ACT Branch President Renae Beardmore says the introduction of electronic prescribing will not only have a positive impact on workflow in the pharmacy with opportunities to streamline dispensing services but is also an important tool when it comes to medication safety.

Read more

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The reasoning behind this being pinned down to cost and lack of services, according to a report released by the Australian Institute of Health and Welfare (AIHW).

The report findings:

• 1 in 4 Australians (24%) said they did not see a GP even when they felt they needed to.
• 1 in 2 (50%) Australians who didn’t see a GP said they could not get an appointment.
• 4 in 10 (45%) Australians who didn’t see specialist when needed said it was because of cost.
• Australians with high health needs were more than 3 times likely to not visit a GP when needed compared with Australians with low health needs.
• Compared with people in cities, remote Australians were more than 8 times as likely to not see a GP and more than 24 times as likely to not see a specialist when needed to due to lack of services.

“We know that 1 in 5 Australians aged 45 to 74 have a high risk of having a heart attack or stroke in the next five years,” explains Heart Foundation Risk Reduction Manager, Natalie Raffoul.

“This is why it’s concerning to see so many Australians aged 45 and over who are not seeing a doctor when they feel they need to.”

Support for the future

Ms Raffoul says that the introduction of Medicare-subsidised Heart Health Checks in 2019 was a big step forward in giving thousands of Australians access to an essential preventive health service.

“We need to support GPs and primary healthcare professionals so they can provide remote Australians with the same opportunities to reduce their risk of heart disease as their city counterparts.”

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The survey by Associate Professor Ben Colagiuri of the School of Psychology at the University of Sydney, and Dr Kate Faasse of UNSW Sydney, examined rates of use and beliefs about placebos in Australian general practice using a random national survey of 136 GPs.

Key findings include that 77 per cent of the GPs had offered an active placebo such as antibiotics for a virus, and 39 per cent an inert placebo such as saline spray or a water based cream.

The survey indicated the most common type of active placebo prescribed was antibiotics, an active medication not designed to be used in this way.

The reason most cited by doctors for prescribing inert placebo treatments was that they perceive placebo treatments have genuine benefits for patients and view themselves as having a strong role in shaping patients’ expectations. This finding may reflect increased knowledge about the value of placebo effects.

The second most cited reason given in the study was that a patient expected or demanded a treatment. An estimated one in five patients makes at least one request for a prescription or other medical service during clinical consultations, and such requests substantially increase the likelihood of receiving the requested outcome.

The decision to meet these demands may result from the increased time pressure in medical consultations or the need to expedite difficult interactions or to avoid negative patient responses to refusal.

Choosing to administer a placebo may be an attempt to appease the patient while minimising the risk of harm from an unneeded medication. However, the Pharmaceutical Society of Australia (PSA) said the revelations this week that doctors are prescribing medicines they know are not indicated for the conditions the patient has presented with, demonstrates why pharmacists must be more actively involved in medication management in Australia.

“Prescribing unnecessary drugs to patients is not good practice in terms of quality use of medicines,” PSA National President Associate Professor Chris Freeman said. “The more medicines a person has to take and manage the more risk there is of a medication related problem.

“While there may be some situations in which a placebo might help a patient, the research released this week found doctors were most likely to prescribe an antibiotic. Unnecessary prescription of antibiotics can not only cause patients harm but impact on the future effectiveness of these vital medications.

“Antimicrobial resistance means when we get sick in the future, antibiotics will not be able to fight the bacteria causing the infection. There is also a cost to the health system every time a placebo medication is prescribed.

“Safe and quality use of medicines was declared a National Health Priority Area last month. The regular prescribing of active placebos – real drugs that won’t address the underlying condition – seems to fly in the face of all we’re trying to achieve.

“Increased utilisation of pharmacists as part of a collaborative healthcare team, including within general practice, will improve medication management and help educate consumers about quality and safe use of medicines.”

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New analysis in the letter, published in JAMA Internal Medicine, reveals pharmaceutical industry payments to Australian non-prescribing healthcare professionals such as nurses and pharmacists are substantial, raising questions around influence and a call for greater transparency.

The analysis provides a unique insight into the nature and extent of payments to non-prescribing healthcare professionals, including nurses, pharmacists, physiotherapists, psychologists, dietitians and others.

According to the research team from the University of Sydney and University of Toronto, there is growing awareness that payments by the pharmaceutical industry to doctors – including the provision of even a modest meal at company-hosted events – are associated with poorer quality prescribing behaviour and increased healthcare costs. The letter says these payments remain commonplace, even as transparency around such payments is in decline in Australia.

Less well understood is how pharmaceutical companies engage with other, non-prescribing healthcare professionals that also play a vital role in patient care, medication management and healthcare administration – and what influence this might have.

“There is a mistaken idea that non-prescribing healthcare professionals don’t have much influence on medicine use, therefore their pharmaceutical industry ties aren’t that important,” said lead author Dr Emily Karanges from the University of Sydney’s Evidence, Policy and Influence Collaborative at the Charles Perkins Centre and School of Pharmacy.

“Yet healthcare professionals like nurses and pharmacists often assist with medication choice and encourage adherence to treatment, and the roles they play in chronic disease management are expanding too.”

The research team analysed payments to Australian healthcare professionals, using publicly available reports submitted to regulator Medicines Australia by their member companies.

The data did not include all pharmaceutical companies, research-related payments or product details associated with payments. However, the analysis provides the first comprehensive account of payments to non-physicians.

Between October 2015 and April 2018, 14,018 healthcare professionals were found to have received $62,695,095 in pharmaceutical industry payments.

While most payments were to doctors, other healthcare professionals accounted for 22.1 per cent of recipients and 16.1 per cent of payments, yet received just 10 per cent of total spend. Nurses and pharmacists were the primary recipients after doctors.

Nurses accounted for 17.8 per cent of recipients but received 8.3 per cent of expenditure, and pharmacists accounted for 2.9 per cent of recipients and received 1 per cent of total spend.

Payments were reported to support activity such as attendance at meetings and speaker and advisory board engagements, as well as associated travel and accommodation costs.

“For the benefit of patients, and to protect and maintain the integrity of our valued healthcare providers, we need better oversight, understanding and education of the potential impacts of such activity,” Dr Karanges said.

Co-author of the research, Professor Lisa Bero, also from the University of Sydney’s Charles Perkins Centre and School of Pharmacy, said the findings had global implications.

“Pharmaceutical companies are clearly courting non-prescribing healthcare professionals as well as doctors in Australia, presumably because of the increasingly important role and influence they have in clinical care,” she said.

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