Better use of medicines has a role in mental health care

04/11/2019

 

The Pharmaceutical Society of Australia is urging the Government to tackle the challenge of improving the use of medicines in the treatment of mental ill health.

 

“Mental ill-health is a major health challenge in Australia and we welcome the Productivity Commission’s commitment in its Draft Report on Mental Health to improving prevention, detection and treatment,” Pharmaceutical Society of Australia National President A/Prof Chris Freeman said.

 

“Unfortunately, what the draft report seems to overlook is the need for improved medicine safety practices and strategies for people with mental ill health and across mental health services.”

 

This is even more important given the recent announcement by the COAG Health Ministers that medicines safety and the quality use of medicines will be Australia’s 10^th National Health Priority Area.

 

A report from the Australian Commission for Quality and Safety in Healthcare in 2017 identified consumers and carers need more personalised information about their medicines. Consumers and carers also expressed a need to be more engaged in shared decision making around treatment options, including the use of medicines.

 

Another finding is that monitoring of the effects and side effects of medicines is frequently inadequate, with confusion about the responsibilities of different clinicians contributing to the problem.

 

“We need to ensure we are using medicine as effectively as possible in the treatment of mental ill-health. For this reason, PSA does not think it is possible to look at mental health care without considering the safe and quality use of medicines,” A/Prof Freeman said.

 

“When a medicine is required, it is important that people with mental ill-health are prescribed the medicine most appropriate for them and their response and reaction to medicines is appropriately monitored and reviewed.

 

“PSA welcomes the funding for research into the use of pharmacogenomics announced by the Minister for Health recently and we expect the Productivity Commission to also explore how we can improve prescription and use of medicines in the treatment of mental ill-health.”

 

Announcing the investment recently, the Minister stated: “Although psychological strategies are the first-line of treatment, antidepressants and other drugs form an important part of the care provided. But only about half of patients have a positive response from their first medication prescription, and the response diminishes with subsequent alternatives.”

 

“PSA support this statement. Medicines have a role in mental health care and we must make sure they are used safely and effectively.

 

“Mental ill-health has a significant impact on individuals, their friends and families and the community as a whole,” A/Prof Freeman said.

 

“To really make strides towards reducing this burden and making a difference in the lives of the more than 10 million Australian adults, who will experience mental ill health at some point in their lives, we must examine all aspects of their health care including treatment – and the most appropriate treatment at some point may include medicines.

 

“PSA will be making a written submission calling on the Productivity Commission to include recommendations in its final report on improving the use of medicines in the treatment of mental ill-health.”

 

Media contact: PSA Media – 0487 922 176

 

Download the media release here

Medicine safety to be the 10th National Health Priority Area

1/11/2019

 

The Pharmaceutical Society of Australia commends Federal, state and territory health ministers for making medicine safety the 10th National Health Priority Area and recognising the urgent need to ensure medicines improve the health of Australians, not put them at risk of harm.

 

“Use of medications is the most common intervention we make in health care. Medicines are meant to help us get better, not make our health worse,” Pharmaceutical Society of Australia National President A/Prof Chris Freeman said.

 

“As PSA’s Medicine Safety: Take Care report found 250,000 Australians are hospitalised each year and another 400,000 present to emergency departments as a result of medication errors, inappropriate use, misadventure and interactions. At least half of these problems could have been prevented.

 

“The annual cost of medication-related hospital admissions in Australia is nearly $1.4 billion. This is equivalent to 15 per cent of total PBS expenditure and is money that could be much better spent.” This cost doesn’t include extra presentations to emergency departments or to general practice or community pharmacy.

 

“PSA applauds our state and territory health ministers and Commonwealth Health Minister, Greg Hunt on agreeing at today’s COAG Health Council meeting to make medicine safety the 10th National Health Priority Area.

 

“PSA commends the decision by the nation’s health ministers to commission a baseline report on quality use of medicine and medicine safety to identify the prevalence of harm and collect evidence of use and misuse of medicines.

 

“But it must not stop there. There needs to be meaningful commitment from all parties involved in healthcare delivery, including health professionals, peak organisations, and government to reduce harm from medicines use. PSA’s Medicine Safety: Take Care report has been the catalyst for this announcement.

 

“PSA commits to leading the effort on behalf of patients and pharmacists to ensure that the objective of safe and quality medicines use is realised. We look forward to working with the Australian Commission for Safety and Quality in Healthcare and the Australian Digital Health Agency.”

 

PSA believes a number of additional measures can be implemented without delay which will make a real difference to improving the health care of Australians. The 7th Community Pharmacy Agreement provides an opportunity to reduce harm from medicines use, and the significant burden that this harm has on our healthcare system

 

“There is also an opportunity for a focus on medicine safety to be part of the National Health Reform Agreements. Research released last week found pharmacist-led medicine charting in hospitals reduced the proportion of patients with at least one medicine problem from 66 per cent to 3.6 per cent,” A/Prof Freeman said.

 

“Pharmacists are medicines experts. They must to be supported to spend more time – both in the community pharmacy setting and other parts of the health care system, including aged care facilities – reviewing patients’ medications, providing advice to members of the health care team, and educating consumers about medicine safety.

 

“It is also time to review the National Medicine’s Policy and make sure it reflects contemporary health care needs and practices. Australia’s National Medicine Policy is now 20 years old and needs a review and refresh as previously announced by the Minister for Health.

 

A/Prof Chris Freeman said “If we are serious about achieving quality and safe use of medicines, three areas need to be of the highest priority. One, a comprehensive data evaluation framework needs to be developed to support the monitoring and reporting of medicines safety measures. Two, there needs to be greater awareness of medicines safety and its implications, and three, we need evidence-based interventions tested and implemented across settings to improve the health of Australians.”

 

Media contact: PSA Media – 0487 922 176

 

Download the media release here.

Time for action

31/10/2019

 

The Royal Commission into Aged Care interim report released today demonstrates the critical problem with medicine management in aged care, showing the urgent need for fundamental change.

 

Pharmaceutical Society of Australia National President A/Prof Chris Freeman said that a third of submissions expressing concern about medicine management is a reflection of the systemic failures in how medicines are used in aged care.

 

The interim report details “widespread overprescribing, often without clear consent, of drugs which sedate residents, rendering them drowsy and unresponsive to visiting family and removing their ability to interact with people.”

 

“There is no doubt that the absence of regular pharmacist services in aged care facilities is causing harm. Pharmacists are there to keep people safe from medicine-related harm. When you don’t have the right level of investment in pharmacists, this is the outcome which results” A/Prof Freeman said.

 

“Unfortunately, this is nothing new. PSA’s Medicine Safety: Take Care report identified 98% of people living in aged care facilities have at least one medicine-related problem.

 

The interim report identifies inadequate funding for medication management review programs for residents of aged care facilities.

 

“Pharmacists are well aware of these problems. PSA members have told us they feel handcuffed by lack of funding and regulatory barriers which prevent them from protecting residents from the harms caused when medicines are not used in a safe and effective way.

 

The report also found the use of psychotropic medicine was not clearly justified in 90% of cases in which they are prescribed in aged care.

 

“This is why PSA has called for pharmacists to work with GPs through collaborative prescribing arrangements. This should be progressed as a matter of urgency,” A/Prof Freeman said.

 

The report identifies the role the 7th Community Pharmacy Agreement (7CPA) will play in responding to the overuse of psychotropic medicines in aged care.

 

“PSA will act on the suggestions directed to us by the Royal Commission in the interim report. We will do everything we can to ensure residents are protected from the harms medicines are causing in aged care.

 

“When the Royal Commission into Aged Care interim report is titled ‘neglect’, we must all stand up and listen. That includes health professionals, the aged care sector, and importantly, government.

 

“We must all take responsibility in designing the improvements that are needed to protect our older Australians.

 

Media contact: PSA Media – 0487 922 176

 

Download the Media Release here.

Australian research confirms pharmacist-led medicine charting reduces duration of hospital stays

Pharmacist-led medicine charting has been shown to reduce the average duration of hospital stays from 4.7 days to 4.2 days in Australian research published in the British Journal of Clinical Pharmacology.

 

The 12 month study of 8,648 general medical patients in eight Victorian hospitals studied a collaborative model of medicine charting between pharmacist and doctors.

 

The model involved a pharmacist taking a medicine history, conducting a blood clot risk assessment and then having a face-to-face discussion with the admitting doctor before agreeing on a medicine management plan. This meant medicine problems were found and fixed on-the-spot at the point of admission, rather than placing the patient at risk for hours or days during their hospital stay.

 

The results found the proportion of patients with at least one medicine problem dropped from 66% to 3.6%. Reducing exposure to medicine-problems at admission was likely a major contributor to the reduced average duration of admission.

 

“Medicine safety is in the DNA of pharmacists. It is not surprising that when hospital pharmacists are more involved in taking a medicine history and charting medicines that patients are safer, and that this leads to shorter hospital stays.” Pharmaceutical Society of Australia National President A/Prof Chris Freeman said

 

“On top of the obvious benefit of patients being safer and getting home sooner, there are clear financial benefits to our stretched health system from patients experiencing shorter hospital stays which stem from higher-quality episodes of care.

 

“Models of care like this pharmacist-led medicines charting initiative need to become normal care for all patients in all hospitals if we are serious about medicine safety. Whatever Australian hospital a patient is in, they deserve to receive access to high quality pharmacist care like this.”

 

“We welcome this research as it adds further weight to PSA’s call in Pharmacists in 20232 for hospital pharmacists to be available at comparable levels regardless of location, timing or nature of stay to make patients in Australian hospitals safer.”

 

Media contact: PSA Media – 0487 922 176

 

Download the media release here.

PSA welcomes regional pharmacist mental health training support for pharmacists and patients

PSA welcomes the NSW Government funding announcement to train pharmacists in regional areas to identify and assist patients with mental health issues.

 

It is estimated that close to half (45.5%) of the Australian population between 16 and 85 years of age will experience a common mental illness in their lifetime with the prevalence of mental health issues, such as depression, increasing with other chronic conditions.

 

These mental health challenges are even more common in rural Australia, where pharmacists are the most accessible healthcare professional, working in close collaboration with doctors and nurses.

 

Pharmacists are well placed to support these patients in the community and identify them early so they can be referred to appropriate mental health providers, including GPs. Evidence suggests that prevention and early interventions can reduce the need for more complex and costly interventions.

 

Patients in regional areas have greater difficulties in accessing these services with patient experience data showing one in three patients living in outer-regional, remote and very remote areas having difficulty accessing services.

 

PSA NSW President Professor Peter Carroll said that “Pharmacists are trusted and accessible health professionals, often coming in contact with consumers with mental health issues, and for the majority of people with lived experience of mental health issues treatment is best provided in the community”.

 

Professor Carroll said it is pleasing to see that collaborative efforts involving both the Pharmacy Guild of Australia, and the PSA have resulted in tangible investment in supporting the pharmacy workforce to improve the mental health of the NSW community.

 

“The Pharmaceutical Society of Australia fully supports the announcement by the NSW Government and looks forward to working with them to equip pharmacists in further supporting these communities”.

 

Media contact: PSA NSW, Simone Diamandis 0414 574 754

 

Download the media release here.

Pharmacists monitoring medicine safety

Pharmacists have taken a lead role in reporting medicine and vaccine side effects and helping ensure therapeutic goods available in Australia are safe and fit for their intended purpose.

 

The Therapeutic Goods Administration (TGA) Annual Performance Statistics Report released this week revealed that over 24,000 medicine and vaccine adverse reaction reports were made during that period.

 

According to the report, the most prolific reporters among health professionals were pharmacists.

 

“Of those reports made by health professionals, nearly half were lodged by pharmacists, including hospital pharmacists,” Pharmaceutical Society of Australia National President A/Prof Chris Freeman said.

 

“Medicine-related side effects are reported to the TGA for assessment and make a vital contribution to medicine safety in this country. PSAs Medicine Safety: Take Care Report indicated that 1.2 million Australians experienced an adverse reaction in the past 6 months. What this does highlight however, is that a lot more can be done to encourage adverse event reporting, and pharmacists, as expected are leading the way in this area.”

 

“Pharmacists are medicine experts; they also spend a lot of time with consumers talking about their medicine use and any side-effects or issues they may have experienced. It is no surprise that they are more aware of adverse reactions and most likely to report them.”

 

Products for which therapeutic claims are made are assessed by the TGA and entered on the Australian Register of Therapeutic Goods (ARTG). At 30 June 2019, there were 88,788 therapeutic goods on the ARTG, including 31,987 new products added during the reporting period.

 

“The number of new listed medicines entered into the ARTG this year was 1,893,” A/Prof Freeman said. “Last year it was 1,792. When you consider the vast number of new medicines being constantly released, the importance of having medicine specialists – pharmacists – providing advice and support to consumers is clear.”

 

“Use of medicines is the most common intervention we make in health care, which unfortunately means problems with medicine use are also common.”

 

“As the custodians of medicines safety in the healthcare system, the early identification of medicine adverse effects through established reporting systems is vital and this highlights the vital role of pharmacists.”

 

“The TGA report shows the profession takes its responsibility very seriously and prioritises medicine safety.”

 

Media contact: PSA Media – 0487 922 176

Limited oversight of antimicrobial use in aged care puts all Australians at risk

Antimicrobial resistance is one of the greatest challenges facing healthcare in Australia, yet data released today shows prescription rates in aged care facilities are on the rise and residents and care staff receive limited support to ensure that these medicines are being used effectively.

 

The 2018 Aged Care National Antimicrobial Prescribing Survey (NAPS) found nearly 10 per cent of aged care residents were prescribed antimicrobials. This compares to 8.8 per cent in 2017.

 

“In just one year we have seen a significant and concerning increase in antimicrobial prescribing,” Pharmaceutical Society of Australia National President A/Prof Chris Freeman warned.

 

“The World Health Organisation has named antimicrobial resistance as a global health threat. Antimicrobial resistance means our most powerful medicines, such as antibiotics, may no longer be effective in treating infections like pneumonia.”

 

“Over prescription of antimicrobials and misuse of these life saving medicines are factors in the rise of resistance.”

 

According to the latest NAPS, antimicrobial review or stop dates are not documented for 58.9 per cent of prescriptions; the documentation of indication was missing for 25.1 per cent of prescriptions; and almost one-fifth of antimicrobials were prescribed for as needed administration.

 

“This means residents may be taking antimicrobials longer than necessary, or worse when they don’t even need to,” A/Prof Freeman said. “There is no clear finish date or prompt for a health care provider to check in with an aged care resident, or the care staff to make sure they are still taking or have ceased taking an antimicrobial based on their current health. This lack of support to aged care residents, and to facility staff is putting aged care residents and the wider community at risk from the epidemic of antibiotic resistance.

 

“Pharmacists are experts in medicine, with a primary responsibility at all times to see that medicines are used safely, effectively and judiciously.”

 

“PSA would like to see the expertise of pharmacists more broadly recognised and utilised. This is again, another example of inappropriate medicine use within aged care, often caused by the prescriber making the wrong decisions about medicines.”

 

“The report released today highlights the real necessity for pharmacists to have more time in aged care facilities and other health care teams to ensure doctors do the right thing with prescribing medicines so that we can improve the safe use of medicines within aged care.”

 

Media contact: PSA Media – 0487 922 176

Leading Queensland pharmacists honoured

Exceptional Tasmanian Pharmacists recognised

Pharmacist prescribing on the way

The Pharmaceutical Society of Australia (PSA) has welcomed the Pharmacy Board of Australia’s position statement on pharmacist prescribing which outlines the way ahead for pharmacists to prescribe as part of a collaborative health care team.

 

PSA National President A/Prof Chris Freeman said following the extensive work conducted by the Pharmacy Board including competency mapping and broad stakeholder engagement, the position statement now lays the platform for pharmacist prescribing, especially collaborative prescribing to be implemented to support the safe and appropriate prescribing of medicines by pharmacists to improve Australians’ access to healthcare.

 

“PSA is pleased that the Pharmacy Board has concluded that under the National Law there are no regulatory barriers in place for pharmacists to be able to prescribe collaboratively under two of the three models outlined in the Health Professionals Prescribing Pathway (HPPP).

 

‘Prescribing via a structured prescribing arrangement’ and ‘prescribing under supervision’ can be progressed immediately, and implementation of these models through for example, expansion of continued dispensing for chronic disease medicines can address a significant proportion of the administrative burden that community pharmacists see day to day with patients running out of their medicines,”  he said.

 

A/Prof Freeman said collaborative prescribing agreements within general practice, aged care, hospitals, and community pharmacy can address concerns about patients not reaching treatment goals, improve the monitoring of adverse events, and in aged care could go a long way to reducing the medication related misadventure that occurs in this setting.

 

“It is incumbent now upon state and territory jurisdictions with their medicines and poisons legislation to review their legislation to remove any unnecessary barriers to pharmacists ‘prescribing via a structured prescribing arrangement’ and ‘prescribing under supervision’.

 

“We are pleased that the Pharmacy Board has agreed with PSA’s position that there are no regulatory impediments to collaborative prescribing, and that autonomous prescribing would require an endorsement on pharmacists’ registration.

 

“As stated in our Pharmacists in 2023 report, we are committed to enabling pharmacists to practise to their full scope by advocating for expanded roles and new opportunities in prescribing, consistent with their recognised competency framework.”

 

In its submission to the Pharmacy Board, PSA surveyed pharmacists, interns and students to inform its response. Ninety-six per cent of respondents agreed pharmacists are already well placed to prescribe under a structured prescribing arrangement or under supervision.

 

The majority of respondents said they would prescribe under the proposed models, with 57% saying they planned to prescribe under a structured prescribing arrangement as soon as it was implemented.

 

In its submission to the Pharmacy Board, PSA outlined the core principles that must underpin pharmacist prescribing, including:

 

• Safety and wellbeing of the patient are fundamental priorities
• Patients are supported to receive patient-centred care in a timely manner
• Pharmacist prescribers have professional accountability and responsibility to patients as well as other members of the healthcare team
• The pharmacist prescriber works as a member of a collaborative care team with shared responsibility and implements highest standards of communication with patients and other team members
• Separation of prescribing and dispensing functions.

 

“PSA looks forward to working with the Pharmacy Board, state and territory jurisdictions and the wider profession to support pharmacist prescribers by establishing training requirements, implementing legislative and regulatory change, and developing the frameworks for collaborative prescribing” A/Prof Freeman said.

 

Media contact: PSA Media – 0487 922 176