National President’s Message: COVID-19 Update

28 April 2020

 

It is good to feel a genuine sense of optimism for the first time in a while. Promising signs of flattening the curve in recent weeks have been sustained over time. The hard work you and the whole Australian community have done to pivot to a new way of working, providing health care and living is paying off.

 

I am hearing from you that workloads are stabilising, and that a new rhythm of working with COVID-19 is being bedded down. Still busy, still challenging, still exhausting; but a little more stable and a little more predictable.

 

The launch of the COVIDSafe app on Sunday marks a shift towards a new chapter in Australia’s pandemic response – a chapter where hard lockdown measures can slowly be relaxed through sustained COVID19 suppression and the ability to rapidly identify, isolate and supress outbreaks.

 

Only four weeks ago, the prospect of this week’s recommencement of Category 2 and some Category 3 surgical procedures such as colonoscopies, dental filling and cancer screening seemed unfathomable. Even more unfathomable 4 weeks ago are the gentle relaxation of social restrictions announced in the past two days in Queensland, Northern Territory and Western Australia.

 

This optimism, however, is cautious. Australia’s enviable success in surpressing COVID-19 so far has been dependent on extraordinary societal adjustment through adherence to social distancing and Stay-at-Home orders. As frontline health workers, you know the how rapidly an outbreak can spread and undo everyone’s hard work.

 

COVIDSafe contact tracing app

 

PSA is proud to join with 11 other peak health organisations in supporting the COVIDSafe app as a public health measure. As a unified voice, we join with the health minister and the health care community to support and approve the COVIDSafe app as a critical tool in helping Australia fight the COVID-19 pandemic, protect and save lives.

 

Downloading the app to helps protect you, your colleagues, other health professionals, carers and support staff. This will help us protect you and help you protect us.

 

Community privacy concerns regarding the app are understandable. I have been reassured by the unprecedented privacy protections provided by the Human Biosecurity Emergency Determination, and in particular the tight sole-purpose provisions.

 

I have downloaded and activated the COVIDSafe app to my smartphone, and encourage you, your family, colleagues and patients to do so too.

 

COVID-19 case testing

 

All jurisdictions are moving to expand COVID-19 testing criteria to include any person with fever or any acute respiratory symptoms. State and territory leaders have set ambitious targets to identify community transmission in the next two weeks prior to review of current restrictions. This testing expansion will also include some targeted testing of asymptomatic adults, including health care professionals and other frontline health professionals.

 

Out of stock medicines: TGA’s therapeutic substitution fails patients

 

It is with disappointment that I update you on the TGA’s published model of therapeutic substitution. The initiative was intended relieve pressure on doctors and pharmacists and allow patients to maintain ongoing therapy of their essential medicines without delay during an out-of-stock situation through strength and form substitution of the prescribed medicine.

 

The TGA’s website describes the intent of the initiative:

 

“The changes will allow a pharmacist to dispense different strengths of a product (such as two 20 mg tablets in place of a 40 mg tablet) or a different dose form of the same medicine (such as a capsule instead of a tablet). It will also allow a medicine that is prescribed as an extended/sustained release medicine to be substituted for an immediate release medicine, or vice versa.

 

Substitution of a medicine with another product containing a different active ingredient is not considered.”

 

 

However, simple in its intent, the initiative is anything but.

 

In order for the substitution to be permitted the TGA will need to publish a Serious Shortage Substitution Notice on their website to advise what substitutions are and are not permitted. This will selectively be applied to some (not all) medicines on the TGA national medicines shortages list and most likely take significant time to produce.

 

Arrangements for supply of substituted medicines under the PBS has not yet been announced, but PSA understands this too will not be automatic and require a separate manual process. Additionally, changes and clarification of state regulations show implementation will further be limited by red tape, such as the requirement in NSW for gazettal of the substitution notice by the Secretary.

 

This system will not work. It is too complex, too slow, and won’t be invoked for the majority of medicine shortages our supply chains experience. Put simply, it will not achieve its intended benefit of maintaining therapy for patients and taking pressure off doctors and pharmacists.

 

This is not the model PSA supported and took to the TGA Medicine Shortages Working Group. PSA cannot support the need for the TGA to publish a notice before allowing pharmacists to substitute medicines, particularly straightforward substitutions such as the dose and quantity of a tablet. It is not in the public interest. It is not in the profession’s interest.

 

Pharmacists are highly skilled medicine experts and competent to make such substitutions. You don’t need a substitution notice to safely support a patient by substituting 30 x 60mg tablets with 60 x 30mg tablets.

 

I have written to the TGA as a matter of urgency to seek a more workable solution to the increasing challenge of medicine shortages in Australia. I will keep you informed of any progress on this issue.

 

At this point, if you have medicines shortages problems that you believe could be addressed through therapeutic substitution, I urge you to contact the TGA on (02) 6232 8644 to request they issue a serious shortages medicines notice.

 

Digital image prescriptions

 

Digital image prescriptions continue to cause confusion and headaches for you. Nowhere more so than in Queensland, which remains an outlier in failing to introduce enabling regulation for digital image prescriptions.

 

Through social media and our membership team, you and your colleagues have sought advice and clarification as to how this measure applies to your practice in your location. To share these answers, the PSA’s COVID-19 microsite has been updated multiple times in the past week in response to the questions you, our members, have asked. The microsite has also been updated to include more FAQs and state and territory clarity provided to PSA’s team around Australia from state health departments.

 

I urge you to bookmark this page and refer to it regularly.

 

Vaccination

 

As the world grapples without a vaccine for COVID-19, World Immunisation Week (24-30 April) is a timely reminder of the power and importance of vaccination. This year’s theme, #VaccinesWork for All focuses on how vaccines – and the people who develop, deliver and receive them – are heroes by working to protect the health of everyone, everywhere.

 

It comes at a time when community response to COVID-19 related Stay-at-Home requirements potentially places Australians, particularly children, at risk from missed or delayed scheduled vaccination. This is particularly the case for influenza vaccination where stock availability is currently hampering vaccination against seasonal influenza and community awareness of recommendations for children is low.

 

In good news, as discussed last week, additional private market stock of seasonal influenza vaccines is expected in coming weeks.

 

Physical distancing is our new-normal

 

Physical distancing and Stay at Home directives, now aided through tools to accelerate contact tracing, are our best tools to suppress the transmission of COVID-19. Physical distancing will be our normal until such time as alternate prevention measures, such as a vaccine, exist.

 

Normalising physical distancing requirements will require consolidation of some short-term adjustments into long-term adjustments. You should consider how you can consolidate some of the physical distancing changes you have made into sustainable medium-term adjustments, such as:

  • Bedding down delivery and contact-free supply and consultation service options for people over 70 years who should be self-isolating at home and for people who are unwell
  • Demonstrating and actively encouraging physical distancing in the pharmacy
  • Continuing working towards integration of digital initiatives into your practise such as electronic prescriptions, My Health Record, real-time prescription monitoring and telehealth

 

Respecting frontline workers

 

Yesterday, Queensland became the latest state to introduce new penalties for assault and abuse of frontline health workers, including pharmacists. Under the public health order, anyone who deliberately coughs, sneezes or spits on emergency or essential workers faces $1300 fine or a penalty of up to $13,000 if the matter goes to court. I welcome this measure which follows WA and NSW introducing similar penalties and PSA’s written request to each premier and chief minister to do more to protect pharmacists from abuse and violence.

 

On your behalf, I have written to every state premier and territory chief minister to ask them to protect our pharmacists during these uncertain times. Its pleasing to see a number of states responding to these calls.

 

Understanding the impact of COVID-19 on pharmacists

 

As I’ve written previously, COVID-19 is having a big impact on your physical and mental well-being. Stressors such as patient abuse, aggression, workload and seismic workplace changes have had led to fatigue, anxiety and untold stress.

 

Learning more about these impacts is extremely important to help inform government and support you, the profession. I am therefore pleased to see Claire O’Reilly FPS (U.Syd) and Karlee Johnston (ANU) are undertaking research to understand how working as a pharmacist during this frightening and uncertain period has affecting the wellbeing of our profession.

 

I strongly encourage you to participate in the survey as it is essential to have input and data from as many of you as possible in this research to better understand the effect of the pandemic on the profession, and to evaluate this over the duration of the outbreak.

 

It doesn’t matter where you work, or how many hours you work, your experience is important. The survey will be sent out every 2 months for the next 12 months and the research team would appreciate your input in as many of those surveys as possible. Please feel free disseminate the survey link and encourage your pharmacist friends to complete it.

Weekly webinar: COVID-19 and technology

 

Last Wednesday, PSA’s Jarrod McMaugh spoke with a person living with Hepatitis C regarding their experience living with the condition, and the stigma they have faced. It was a candid, compelling and valuable insight into the reality of living with the disease. The webinar will be available via the PSA website shortly I encourage all members who weren’t able to join last Wednesday to watch.

 

This week’s webinar will focus on COVID-19 and telehealth, particularly the follow-up services that have been announced for HMRs and RMMRs COVID-19 has driven uptake of telehealth much faster than anticipated, including the recent announcement by the Government that pharmacists can deliver HMRs, RMMRs and MedsChecks to eligible patients via telehealth.

 

On Wednesday night, I’ll be discussing the latest updates on telehealth, what it means for pharmacists, and what PSA is doing to support you through these significant changes to your daily practice.

 

The webinar will be at 7.30PM EST Wednesday night. Register here.

Stay up-to-date

 

Our dedicated COVID-19 website has seen record traffic in the last week as members sought advice and support from the new ‘summary of regulatory changes’ page. This page has been updated multiple times each day to incorporate more FAQs on the questions you and your colleagues are asking via the member support team and on social media. You can also view videos in which I speak about some of the most pressing issues affecting you.

Changes to Medicine Review Services

Digital Image Prescribing

Your PSA team are working hard to keep you informed and support you during the pandemic. Keep feeding back the issues and concerns which you are working through to help us help you. Please contact us at membership@psa.org.au.

 

Sincerely,

Associate Professor Chris Freeman

National President

Pharmaceutical Society of Australia