National President’s Message: COVID-19 Update

26 May 2020

 

As the pandemic grows by more than 100,000 new cases globally each day and the epicentre shifts to South America, in Australia, it feels like the worst is behind us with only 5-10 new cases reported nationally each day.

 

In the past week, Premiers and Chief Ministers around the country have announced and implemented a modest winding back of restrictions, which have included guidance on modifications needed to reopen business and the community in a modified ‘COVID-normal’ way. In doing so, they have emphasised these restrictions are likely to be our new normal for a long, long time – likely to be normal until a vaccine is developed.

 

There are positive signals on the vaccine development front with a US biotechnology company beginning human trials in Australia (Melbourne and Brisbane) of a coronavirus vaccine. The trial will focus on the safety aspects of the vaccine and will also look for early signs of effectiveness. There is now about a dozen experimental vaccines which are in early stages of testing or on the eve of commencing, mostly in the US, Europe, and China.

 

As the rest of Australia transitions from lockdown to COVID-normal, actively consider; what does your COVID-normal looks like? What semi-permanent changes do you need to make to your practice? How will you maintain increased infection control, physical distancing for staff/patients and supporting unwell people stay-at-home (staff and customers) until a vaccine is developed? What temporary signage and process workarounds need to become embedded as being more permanent?

 

Supporting you with electronic prescriptions: starting now

 

Temporary digital image prescriptions during COVID-19 have been critical to ensure the supply of medicines during the global pandemic – but it has put significant pressure on you with regulatory confusion and in some instances has put pharmacists in regulatory peril.

 

I welcome the imminent implementation of electronic prescribing in a staged and planned approach – which will see a safer, clearer and more secure prescribing model, supporting pharmacists and protect patient’s privacy and safety.

 

I am confident that the work PSA has done with the Australian Digital Health Agency will result in the reduction of many of the bugbears and regulatory issues of digital image prescribing and paper prescriptions.

 

As electronic prescriptions go live, it’s important you what to do when the first patient presents an electronic prescription to you in your practice.

 

To support you, PSA, in partnership with the Agency now offers a dedicated electronic prescribing support line for pharmacists. The support line is staffed by experienced pharmacists who have access to the latest workflow information on how to adopt electronic prescriptions.

 

You can contact the support line on 1300 955 162 (8:30am to 7:00pm AEST, Monday to Friday) or email ep@psa.org.au.

 

PSA has also created a dedicated electronic prescribing webpage which contains all the latest up to date information and resources for pharmacists: www.psa.org.au/ep.

 

Webinar: Electronic prescriptions

 

This Wednesday night, the agency’s Andrew Matthews MPS, Director of Medicine Safety Programs, and Kate Ellis Manager, Provider Adoption will join me to discuss everything you need to know about electronic prescriptions and answer your questions.

 

7.30pm (EST) Wednesday 27 May

Register here.

 

PBS opioid changes from 1 June

 

The Australian Government, through the Department of Health, is implementing a range of changes to minimise the harms to Australians caused by opioid medicines. One of these measures is PBS changes which affect prescriptions written from 1 June.

 

These PBS changes include amendments to existing restriction requirements and arrangements for increased quantities and repeats. In addition, there are new Restricted Benefit listings for smaller maximum quantities of immediate release opioids, with no increased quantities or repeats, for patients requiring short-term relief of acute severe pain.

 

The 1 June PBS changes affect most opioid Controlled Drugs, as well as tramadol and paracetamol+codeine combination products.

 

I encourage you to start socialising these changes with your patients and medical colleagues to help transition as smoothly as possible to these new arrangements.

 

Supporting Australians to put their health first

 

On behalf of PSA, I am pleased to join with other peak bodies and consumer support groups in calling Australians to take action to avoid a second wave of health problems from reduced screening, management and monitoring of serious health conditions.

 

This call, in an open letter to Australians, encourages people to get the health care they need, whether that be screening, getting treatments from an allied health provider or having a telehealth consultation with their pharmacist.

 

Now is the time to reach out to patients who have disengaged from managing their chronic health conditions, particularly those who you may not have seen for a while. This can include undertaking medicine reviews, calling patients you haven’t seen for a while, discussing adherence during repeat dispensing or providing recommendations for screening services when non-prescription medicine requests warrant.

 

Provisions for medicine review services (e.g. Medschecks, HMRs) to be conducted via telehealth are available and I encourage you to promote them to your patients where they provide an avenue for people trying to avoid public contact to get the expert pharmacist care they need.

 

Medicine limits and restrictions remain

 

I am pleased to hear many of the medicine shortages which arose in March and April from increased patient demand for prescription and non-prescription medicines – in particularly salbutamol, paediatric analgesics, hydroxychloroquine – are well on their way to returning to more stable levels.

 

Back in March, PSA, together with the Government, the Pharmacy Guild of Australia and the National Pharmaceutical Services Association agreed to dispensing and supply limits for nominated medicines. Your hard work, the work of all pharmacists and the work of suppliers has been absolutely essential to restoring stability in the supply chain; helping medicines be available for everyone.

 

Limitations to the Schedule 3 listing of salbutamol are a permanent regulatory change; meaning the single inhaler limit and requirement for the patient to provide evidence of medical diagnosis of a respiratory condition or dispensing history at the supplying pharmacy remain.

 

As we move to a COVID-normal environment, it is essential adherence to these limits continue to maintain ongoing stability of the supply change. As many of you are aware, a large number of medicines remain out-of-stock or on constrained supply. Continuing to play our part helps ensure essential medicines will be available to as many Australians as possible when they need them. Something more important than ever as we focus on consumers with management of their chronic health conditions.

 

The non-COVID19 curves likely to rebound

 

Social distancing hasn’t just flattened and squashed the COVID-19 curve, it has also limited the transmission of other infectious diseases. Confirmed cases of other notifiable infectious diseases such as influenza, chlamydia and norovirus have been significantly lower in recent months. While some of this may be attributed to people not seeking usual medical care and pathology testing, limited social interaction and increased infection control measures has seen dramatic drops in community prevalence of these conditions.

 

The graduated return to workplaces, schools and social gatherings in a COVID-normal community will likely see increased rates of non-COVID infectious diseases, with health authorities renewing calls for influenza vaccination this week.

 

When responding to queries about respiratory conditions, the messages we have become accustomed to during COVID-19 remain the same: Stay at home if sick. Get tested if you have unexplained fever or any respiratory symptoms. Maintain physical distancing. Limit social interaction if vulnerable. Download the COVIDSafe App.

 

Your voice to parliament: highlighting the lessons of COVID-19

 

This week PSA will be submitting its response to the Senate Inquiry into the health response to COVID-19, which will highlight the challenges faced with medicines shortages, digital image prescribing and regulatory confusion. It will outline important lessons learnt as well as examine the extraordinary strength and purpose pharmacists demonstrated in supporting Australians under unparalleled pressure and community panic.

 

In the submission we will be highlighting the challenges faced with medicine shortages, digital image prescribing, regulatory confusion between the Commonwealth and state jurisdictions and the challenges with the TGA’s Serious Shortage Medicine Substitution Notices.

 

I will share the submission with you once it has been published on the Senate’s website.

 

Providing further clarity on emergency supply options

 

How well do you know your state/territory legal requirements for phoned/faxed prescriptions?

 

What conditions need to be met to use the emergency supply ‘3-day rule’ if someone doesn’t meet the requirements for Expanded Continued Dispensing (or one month emergency non-PBS supply during where allowed)?

 

The application of these requirements has been a point of tension with prescribers during COVID-19 where they need to be followed when prescriptions aren’t eligible to be supplied under temporary COVID-19 provisions (digital image prescriptions and Expanded Continued Dispensing).

 

Our dedicated COVID-19 microsite has been updated with state-specific mapping these requirements to help clarify requirements for prescriptions unable to be supplied as digital image prescriptions or under Expanded Continued Dispensing arrangements.

 

The microsite also continues to be updated daily with information relevant to your practice.

 

Sincerely,

Associate Professor Chris Freeman

National President

Pharmaceutical Society of Australia

National President’s Message: COVID-19 Update

19 May 2020

 

Two months ago when COVID-19 led to the rapid implementation of Stage 3 restrictions, it seemed impossible that by mid-May we would have seen cafes and restaurants reopening, boot camps recommencing and multiple jurisdictions achieving zero active known COVID-19 cases. For many in the community, there is a feeling that the worst of the pandemic is behind us, and there is agitation to return to our pre-pandemic lives.

 

I echo the sentiments of Professor Michael Kidd, Deputy Chief Medical Officer on Saturday that everyone must remain vigilant, and that the relaxation of restrictions is not a signal the pandemic is over and not a signal to return to life as it was pre-COVID-19. In the past few days, we have seen news headlines of new cases prompting workplace shutdowns, including multiple fast food stores, a furniture warehouse and a department store. We have also seen public criticism of people who attended workplaces providing health support when unwell.

 

We are moving into a ‘business as unusual’ environment where we reopen our community in a way which recognises and respects the ongoing presence of a virus to which we currently have no effective pharmacological treatment or community immunity.

 

In your practice, to your family and to your friends, promote and exhibit the modified norms: ongoing physical distancing, rigorous hand hygiene, staying home and being tested if sick and enhanced cleaning.

 

Serious Shortage Medicine Substitution system falls seriously short

 

You would likely be aware that the TGA last week published the first Serious Shortage Medicine Substitution Notice (SSSN) as part of its medicine shortages initiative. The initiative is meant to help patients continue to access medicines without delay during stock shortages, but the way it has been set up will make this difficult to achieve.

 

In this case, metformin XR 500mg is expected to be out of stock until at least early June. The TGA SSSN outlines three permitted substitutions based on total daily dose:

• 1500mg daily: substitute with metformin 1000mg XR and metformin 500mg IR
• 1000mg daily: metformin 1000mg XR
• 500mg daily: metformin 500mg IR

 

The permitted quantity to supply aligns to the equivalent doses to what was prescribed.

 

Does an SSSN make substitution by pharmacists legal?

 

As laws governing supply of medicines are state/territory-specific, whether you are allowed to make this substitution depends on where you practice – and each state and territory has incorporated it differently.

 

You are allowed to make the substitution unless you are practising in Victoria or South Australia – neither state has issued a public health order required to enable the substitution. For a more complete understanding of the regulation in your location, click here.

 

Is an SSSN recognised for PBS supply?

 

No. There is no provision to supply under the PBS when medicines are substituted under this approach. Even through metformin XR is a relatively low-cost medicine, this increase in out-of-pocket costs is a problem for some patients. For more expensive medicines, lack of PBS eligibility will render the SSSN impractical as patients will be better off delaying treatment to get an alternate prescription from their doctor.

 

When therapeutic substitution for medicine shortages was first tabled jointly by both the PSA and the Pharmacy Guild of Australia, this is not the model we put forward. In our view, the system is too complicated, too slow to respond to shortages, too inflexible to take into account local medicine shortages, and too bureaucratic to recognise pharmacists’ competence to make, what are largely, straightforward substitutions.

 

PSA will continue to work with state, territory and federal governments to improve patient access to medicines during shortages – with our first priority being to improve the workability of these arrangements. Together with the Guild, we will be following up with state and territories to modify state regulation to improve this system for pharmacists and the health and safety of patients.

 

Electronic prescriptions just a few weeks away

 

Electronic prescriptions remain a hot topic and one of strong interest to the profession, particularly as many of you are weighted down under a mountain of administratively complex digital image prescriptions.

 

Electronic prescriptions remain on target for implementation from the end of this month, with some prescribing and dispensing software providers expected to include its functionality in June software updates.

 

Last Wednesday night, I hosted an electronic prescriptions webinar in partnership with the Australian Digital Health Agency. We had more than 500 pharmacists join us for the live event, with a high level of engagement, interest and questions regarding how the initiative will work.

 

Webinars on electronic prescriptions will become a fortnightly event in coming months to ensure your questions and as you start to see them come through in your practice.

 

National Mental Health and Wellbeing Pandemic Response Plan

 

National Cabinet, last Friday, unanimously agreed to a nationally consistent approach to responding to mental health challenges which arise from the pandemic. The approach is described in the National Mental Health and Wellbeing Pandemic Response Plan, with suicide prevention a strong focus. The plan consists of:

1. Data and modelling: including a focus on real-time data to identify emerging issues
2. Outreach: focused on helping vulnerable communities, including older Australians, carers of people with mental illness, culturally and linguistically diverse communities and indigenous Australians
3. Connectivity: including a public communications campaign titled: “It’s OK not to be OK”

 

The approach will work towards a ‘no-wrong-door’ approach to services, that wherever a person goes, they will be connected to part of the health system that can provide the services people need.

 

As I discussed last week, pharmacists are often a first point of contact for trauma-affected communities. Patients you interact with will present with signs and symptoms of mental health challenges, which can include reaching out to you in an indirect way. In supporting the ‘no-wrong-door’ approach outlined in the plan, I encourage you to know what options are available in your area and to connect patients to these services.

 

If you live in an eligible bushfire affected and have not already done so, I encourage you to sign up for the fully funded Mental Health First Aid training being run during May and June. Details the dates for these two-part workshops in your area are available here. If you don’t live in these areas, I encourage you to investigate other MHFA training in your area, such as those offered through PSA.

 

Webinar: MATOD in the time of COVID-19

 

As Australia cautiously eases restrictions, we are on a path towards ‘business as unusual’. So what will ‘business as unusual’ look like for your opioid substitution patients and services?

 

Join me on Wednesday night as Pene Wood, Lecturer of Clinical Pharmacy at LaTrobe University joins me to discuss the arrangements in place to support people living with opioid dependence on methadone or buprenorphine therapy.

 

7.30pm (EST) Wednesday 20 May

 

Register here.

 

Stay up-to-date

 

Our dedicated COVID-19 microsite has been updated with state-specific mapping of how the TGA SSSNs apply in each state and territory – as well as daily updates with information relevant to you.

 

Sincerely,

Associate Professor Chris Freeman

National President

Pharmaceutical Society of Australia

National President’s Message: COVID-19 Update

12 May 2020

 

Friday’s release of the Roadmap to a COVID Safe Australia marks a significant shift in Australia’s response to COVID-19. It marks significant achievements in Australia’s work to supress transmission of COVID-19 in the community. It marks a shift towards reopening businesses in forced hibernation. And it marks a shift towards social and family interactions.

 

Both from a sense of achievement and risk, the key change is that it marks a shift towards exponentially more human-to-human interaction in the Australian community.

 

All federal, state and territory leaders have reinforced, repeatedly, that this represents risk of increased transmission of COVID-19 and the risk of outbreaks. They have emphasised the roadmaps each jurisdiction is adopting are incremental stages.

 

As frontline health providers and as members of the Australian community you have an important role to play in helping your community transition to a COVID-Safe ways of living.

 

As people start to mingle more in returning to workplaces, cafes, restaurants, gyms, schools, swimming pools, shopping centres and on public transport; physical distancing, hand hygiene and staying home if they are sick is more important now than ever.

 

Be familiar with your local restrictions. Understand how the roadmap will roll-out in your area. Make more permanent changes to your work environment to make it COVID-Safe. Keep referring anyone with even mild respiratory symptoms to testing centres. Reinforce public health messages message with your patients constantly.

 

Collectively we can all make a huge difference in making Australia COVID safe.

 

Electronic prescriptions

 

Last week marked a significant milestone towards the introduction of electronic prescriptions. The first genuine and legally valid electronic prescription was created, stored and dispensed last week in Angelsea, Victoria.

 

Unlike digital image prescriptions, which are – sometimes poor quality – electronic reproductions of paper prescriptions, electronic prescriptions are completely paperless. They will reduce transcription errors and interpretation errors. They will also help consumers access their prescriptions where and when they want them.

 

PSA has been working with the Australian Digital Health Agency (the Agency), for some time on the workflow, support and resources needed to help with an effective and smooth transition to electronic prescriptions. I will continue to keep you updated in coming weeks and months as we welcome this evolution in pharmacy practice.

 

In the leadup to the introduction of electronic prescriptions at the end of the month, I’m pleased to be hosting this week’s Wednesday webinar, in partnership with the Agency to go through the important things you need to know, and answer all your questions.

 

Registration is open to all pharmacists, and available here.

 

Secure messaging

 

As electronic prescriptions advance towards its go-live date, work continues in the development of secure messaging systems. Secure messaging is the safe, encrypted transfer of information between health professionals; more secure, convenient and timely than current communication methods such as post and fax.

 

PSA is working with the Agency to help ensure the systems and technology work for pharmacists, and is seeking your input on what you need the system to do, and your insight into the current way you send and receive information to/from other health professionals. This can include routine sharing of records and data between services (e.g. faxing a dispensing history or Continued Dispensing Notice) or actual person-person communication such as contacting a prescriber directly about an issue or for additional information.

 

I encourage you to participate in the survey which is open until 17 May.

 

Mental health support for bushfire affected Australians

 

Last summer’s horrific bushfire season created significant individual and collective trauma for affected communities. While the media coverage of the recovery has been muted somewhat by COVID-19, colleagues in those areas have described to me the pain and struggle which those communities have and continue to experience.

 

I’m therefore pleased to report that PSA is partnering with the Australian Government to upskill pharmacists and pharmacy support staff in bushfire-affected areas, to support mental health in communities affected by the 2019-20 bushfires.

 

Pharmacists are often a first point of contact for trauma-affected communities and Mental Health First Aid training aims to improve frontline workers’ ability to support community members, promote their own resilience and psychological recovery from the 2019-20 bushfires, and support the resilience and wellbeing of frontline workers’ and their employers.

 

The course has both an eLearning component and two (2) virtual workshops of 2.5 hours each regarding the symptoms, causes and evidence-based treatments for mental health conditions, the early warning signs of mental illness, possible crisis situations arising from mental health problems, addressing crisis situations and the importance of intervening before a crisis develops.

 

The course is fully funded for pharmacists in affected areas and is being run during May and June. Details the dates for the two-part workshop for your area and logistics are available here.

 

Scheduling changes announced: triptans and paracetamol SR

 

The TGA late last week released a series of final scheduling decisions, announcing the following changes relevant to pharmacists:

• Sumatriptan 50mg (2 doses): New Schedule 3 entry from 1 February 2021
• Zolmitriptan 2.5mg (2 doses): New Schedule 3 entry from 1 February 2021
• Mometasone 0.1% (up to 15g): New Schedule 3 entry from 1 June 2020
• Paracetamol modified-release (up to 665mg: Packs of up to 100 tabs become Schedule 3 on 1 June 2020

 

I welcome these changes, particularly in regard to improving access to migraine medicines for people with stable migraine given the immediate need for symptom relieving medicines when a migraine strikes. As new Pharmacist Only Medicines, PSA will be preparing guidance documents to support safe, appropriate supply of these products.

 

To be clear, these changes remain well within the scope of practice of pharmacists, and I have encouraged the medical profession to refrain from providing comment outside their own scope of practice, that is the training and competencies of pharmacists.

 

As we all know, acute presentations like migraines don’t always present 9am to 5pm, Mondays to Fridays.

 

I encourage you to start socialising the change for modified release paracetamol to patients now to reduce confusion in June.

 

Pharmacists advice line

 

Following your feedback, we have worked to improve the way in which we respond to member practice queries. One of ways we are doing this is through the launch of a direct pharmacist-to-pharmacist advice line, offering professional advice from a senior pharmacist exclusively to PSA members.

 

Call on 1300 369 772 between 8.30am to 5.00pm AEST weekdays for professional advice and support on:

• Practice-related queries including APF, professional practice standards and guidelines, competency standards
• Ethics related queries including Code of Ethics and/or ethical dilemmas
• Technical queries about medicines, compounding and medicine availability
• Regulatory queries about legislation and policy matters
• Registration queries including CPD requirements and AHPRA requirements.

 

Stay up-to-date

 

Our dedicated COVID-19 microsite has been updated with state-specific plans to the COVIDSafe Australia Roadmap released last week. PSA will continue to communicate changes with you via this site, social media and in this weekly column.

 

Sincerely,

Associate Professor Chris Freeman
National President
Pharmaceutical Society of Australia

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