Pharmacies In Australia Research Articles

Cleaning up our disinfectants: usage of antimicrobial biocides in direct-to-consumer products in Australia.

In supermarkets and chemists worldwide, consumers are faced with an array of antimicrobial domestic cleaning and personal hygiene products purporting to kill germs and keep people safe. Many of these proven active ingredients (biocides) encourage the development of antimicrobial resistance (AMR) in microbes and microbial populations, in turn increasing the likelihood of AMR infections. In order to understand and address the selective pressure towards AMR posed by the unrestricted use of biocides, it is necessary to understand which biocides are most frequently found in consumer products and the current regulatory framework that governs their use. In this research we survey the biocidal active ingredients in the major categories of cleaning and personal care products available from supermarkets and pharmacies in Australia, and comment on the regulations that dictate how these products are tested and marketed. Benzalkonium chloride and ethanol were the two most prevalent antimicrobial biocides in this study, while triclosan, which is banned in several jurisdictions, was found in a small number of products. In Australia, many antimicrobial consumer products are regulated for efficacy and safety under the Therapeutic Goods Act, but the potential to drive microbial adaptation and AMR is not considered. Overall this survey underscores the broad use and light regulation of antimicrobial biocides in products available to the general public in Australia, and provides an information resource to inform further research and stewardship efforts.

The landscape of self-care in Australia: A pharmacy perspective

The evolving landscape of self-care in Australia underscores the imperative of recognizing and integrating the crucial role of pharmacists in promoting greater levels of self-care. Although the social and economic justifications for self-care are acknowledged internationally and in the literature, there is very little policy recognition in relation to self-care specifically in Australian health policy. Additionally, the distinct contributions of pharmacies to self-care, i.e., their experiences and accessibility in primary health care, are not consistently highlighted. Community pharmacies in Australia are currently navigating a transformative shift, expanding their scope of practice to deliver highly individualized care, with a special emphasis on the implementation of professional services crucial for the sector's enduring viability. Although pharmacists already play a substantial role in supporting self-care, there exists a compelling demand for a systematic and structured approach. Despite the limited availability of theoretical frameworks or models for pharmacists in self-care support within the existing literature, tangible practical evidence attests to the success of interventions. In an era where patients increasingly assume responsibility for self-managing conditions, the pharmacist's role in facilitating self-care and judicious self-medication is pivotal, promising not only tangible benefits for individuals but also contributing significantly to the long-term sustainability of the healthcare system in Australia. This necessitates a strategic and comprehensive framework that positions pharmacists as essential catalysts in the broader landscape of healthcare, ensuring their contributions are optimally leveraged to enhance patient outcomes and system efficiency.

Do the attitudes and practices of Australian pharmacists reflect a need for education and training to provide care for people who are transgender?

Many transgender and gender diverse (TGD) people access care through community pharmacy in Australia. However, there is limited information available about the role of Australian pharmacists in providing care for TGD people. To explore the attitudes, practices, and training needs of pharmacists in the provision of care for TGD people in Australia. Pharmacists Australia-wide were invited to participate in an online survey through Facebook, e-newsletters of pharmacy organizations and a professional pharmacy journal. Quantitative data were analysed for descriptive and inferential statistics. A Fisher exact test was used to investigate associations between two variables. Results with P value <0.05 were considered statistically significant. Content analysis was used to analyse data from free-text responses. Of the 169 respondents, the majority were female (75.1%), aged below 40 years (74%) and with less than 10 years of working experience as a pharmacist (58%). Although 95% of the sample agreed that they had an important role in the provision of care for TGD people, only 29.6% were confident about their knowledge of pharmacotherapeutic treatments for gender affirmation. Only 2.4% had received education about TGD care at university, and only 5.3% received any TGD healthcare training over the past 5 years. Although pharmacists had a positive attitude and recognized their role in TGD care, they expressed a lack of confidence in their knowledge to be a barrier to providing quality care. Most recommended the need for more education about TGD healthcare in pharmacy curricula and continuous professional education activities.

The impact of implementing an allergic rhinitis clinical management pathway (AR-CMaP) in the community pharmacy

BackgroundThe Allergic Rhinitis Clinical Management Pathway (AR-CMaP) was developed to overcome the challenge of implementing current AR guidelines in the Australian community pharmacy practice and support pharmacists in optimally managing patients' AR. Objective(s)To evaluate the impact of AR-CMaP on patients' behaviour and pharmacists' needs in managing AR in the pharmacy. MethodsThis study used a cross-sectional, pre-post study design in which the primary outcome was the appropriateness of medications purchased from community pharmacies in Australia. Patient data were collected before and after the implementation of AR-CMaP. Pharmacist needs were recorded before and after AR-CMaP training. Data were analysed descriptively. ResultsSix pharmacies, 19 pharmacists and a total of 416 patients were included in the study; 206 pre-AR-CMaP implementation and 210 post-AR-CMaP implementation. Pre-AR-CMaP, 22.4% of patients purchased appropriate AR medication compared with 29.0% post-AR-CMaP implementation. Over half the patient cohort (52%) consulted a pharmacist pre-AR-CMaP and 37% consulted a pharmacist post-AR-CMaP implementation. Post-AR-CMaP, pharmacists reported increased awareness of barriers such as patients' lack of time, patients' perceptions about the pharmacist's role and patient choice to self-manage. Pharmacists also rated an increased desire to interact with other health care providers (HCPs) in caring for patients with AR. ConclusionsWhile there was a non-statistically significant increase in the proportion of patients purchasing optimal AR medication, AR-CMaP did empower patients to self-select their own medication without further detriment. Moreover, following the implementation of AR-CMaP, pharmacists developed a greater awareness of their role in AR management, exemplified by their increased desire to be actively involved in AR management and increased interaction with other HCPs. Future research needs to explore more effective tools to support pharmacists' clinical decision-making and target patients' self-selection of AR medications. This study highlights that there is an ingrained self-reliance of AR decision-making that has become a habit for people living with AR.

Physician and nurse practitioner perspectives of a modified Routine Opioid Outcome Monitoring (ROOM) Tool.

Introduction The Routine Opioid Outcome Monitoring (ROOM) Tool was developed for use in community pharmacies in Australia. It facilitates pharmacists' screening and brief interventions regarding an individual's opioid use for chronic pain. At our academic teaching hospital, the ROOM Tool was adapted to incorporate a communication tool that includes a pharmacist's assessment and recommendations for primary care providers. This modified ROOM Tool was implemented as part of usual care in our outpatient pharmacies; however, the value to primary care providers is unknown. Aim The aim of this study was to determine primary care provider perspectives on the modified ROOM Tool. Methods Focus groups were conducted with primary care providers from an Academic Family Health Team. The focus group encompassed topics related to the positive and negative aspects of the modified ROOM Tool in supporting the care of patients using opioids for chronic pain. Qualitative content analysis of transcripts was performed to identify themes. Results Three focus groups were conducted with a total of six participants. Four themes emerged: (i) Facilitators to using the tool, (ii) Barriers to using the tool, (iii) Recommendations for improvement, (iv) Impact of the tool on patient care and safety. Discussion The ROOM Tool paired with the communication tool supports collaboration between pharmacists and primary care providers. The communication tool standardises the approach for communicating the pharmacist's assessment and recommendations. Recommendations to refine this modified ROOM Tool may increase its utility to primary care providers and enhance the impact on patient care and safety.

Immediate Adverse Events Following COVID-19 Vaccination in Australian Pharmacies: A Retrospective Review.

Four COVID-19 vaccines are approved for use in Australia: Pfizer-BioNTech BNT162b2 (Comirnaty), AstraZeneca ChAdOx1 (Vaxzevria), Moderna mRNA-1273 (Spikevax), and Novavax NVX-CoV2373 (Nuvaxovid). We sought to examine the type and management of immediate adverse events following immunisation (I-AEFI) after COVID-19 vaccination. Retrospective review of I-AEFI recorded between July 2021 and June 2022 in 314 community pharmacies in Australia. I-AEFI were recorded in 0.05% (n = 526/977,559) of all COVID-19 vaccinations (highest: AstraZeneca (n = 173/161,857; 0.11%); lowest: Pfizer (n = 50/258,606; 0.02%)). The most common reactions were: (1) syncope, after the first dose of AstraZeneca (n = 105/67,907; 0.15%), Moderna (n = 156/108,339; 0.14%), and Pfizer (n = 22/16,287; 0.14%); and (2) Nausea/vomiting after the first dose of Pfizer (n = 9/16,287; 0.06%), Moderna (n = 55/108,339; 0.05%), and AstraZeneca (n = 31/67,907; 0.05%) vaccines. A total of 23 anaphylactic reactions were recorded (n = 23/977,559; 0.002%), and 59 additional I-AEFI were identified using MedDRA® terminology. Pharmacists primarily managed syncope by laying the patient down (n = 227/342; 66.4%); nausea/vomiting was managed primarily by laying the patient down (n = 62/126; 49.2%), giving water (n = 38/126; 30.2%), or monitoring in the pharmacy (n = 29/126; 23.0%); anaphylactic reaction was treated with adrenaline (n = 18/23; 78.3%) and n = 13/23 (56.5%) anaphylactic reactions were treated with the combination of: administered adrenaline, called ambulance, and laid patient down. The most commonly recorded I-AEFI was syncope after COVID-19 vaccination in pharmacy; I-AEFI are similar to those previously reported. Pharmacists identified and managed serious and non-serious I-AEFI appropriately and comprehensively.

Safety of Four COVID-19 Vaccines across Primary Doses 1, 2, 3 and Booster: A Prospective Cohort Study of Australian Community Pharmacy Vaccinations.

Four COVID-19 vaccines are approved for use in Australia: Pfizer-BioNTech BNT162b2 (Comirnaty), AstraZeneca ChAdOx1 (Vaxzevria), Moderna mRNA-1273 (Spikevax) and Novavax NVX-CoV2373 (Nuvaxovid). We sought to examine adverse events following immunisation (AEFI) at days 3 and 42 after primary doses 1, 2, 3 and booster. We conducted active vaccine safety surveillance from 130 community pharmacies in Australia integrated with AusVaxSafety, between August 2021-April 2022. Main outcomes: AEFI at 0-3 days post-vaccination; medical review/advice at 3 days and 42 days post-vaccination; SARS-CoV-2 breakthrough infection by day 42. Of 110,024 completed day 3 surveys (43.6% response rate), 50,367 (45.8%) reported any AEFI (highest proportions: Pfizer 42%, primary dose 3; AstraZeneca 58.3%, primary dose 1; Moderna 65.4% and Novavax 58.8%, both primary dose 2). The most common AEFI reported across all doses/vaccines were local reactions, systemic aches and fatigue/tiredness. Overall, 2172/110,024 (2.0%) and 1182/55,329 (2.1%) respondents sought medical review at days 3 and 42, respectively, and 931/42,318 (2.2%) reported breakthrough SARS-CoV-2 infection at day 42. We identified similar AEFI profiles but at lower proportions than previously reported for Pfizer, AstraZeneca, Moderna and Novavax COVID-19 vaccines. Moderna vaccine was the most reactogenic and associated with higher AEFI proportions across primary doses 2, 3, and booster.

Primary Care Wound Clinics: A Qualitative Descriptive Study of Patient Experiences in Community Pharmacies.

The expansion of primary care wound services serves to alleviate secondary and tertiary care utilization. However, patient satisfaction is required to ensure service uptake. In recent years, various community pharmacies in Australia have begun to offer dedicated wound clinics; however, evaluations of patient experiences have yet to be conducted. Thus, the present study seeks to explore: (1) the experiences and satisfaction of patients who have received wound care consultations for their acute wounds in a community pharmacy setting; and (2) how current pharmacy-based wound services can be improved. Semi-structured individual interviews were conducted with patients across five pharmacy-based wound care clinics in Western Australia. Interviews were audio-recorded, transcribed verbatim, and imported into QSR NVivo 12 Plus. Interview transcripts were coded and thematically analyzed using the framework method. Twelve interviews were required to reach data saturation. Five key themes emerged: the accessibility of wound services, the comprehensiveness of wound care services, confidence in wound care consultants, the awareness and promotion of wound services, and the expansion of wound care services. Overall, participants were satisfied with the accessibility and comprehensiveness of pharmacy-based wound service delivery, trusted the health care providers, and wanted the service to be expanded. The reported patient satisfaction, confidence in the health care provider, and desire to expand the service suggests there is potential for the service to grow in Australia. Due to the growing costs of wound care globally, there is scope to further evaluate and expand wound care services in the primary care setting on an international level.

Data-driven approach for tailoring facilitation strategies to overcome implementation barriers in community pharmacy

BackgroundImplementation research has delved into barriers to implementing change and interventions for the implementation of innovation in practice. There remains a gap, however, that fails to connect implementation barriers to the most effective implementation strategies and provide a more tailored approach during implementation. This study aimed to explore barriers for the implementation of professional services in community pharmacies and to predict the effectiveness of facilitation strategies to overcome implementation barriers using machine learning techniques.MethodsSix change facilitators facilitated a 2-year change programme aimed at implementing professional services across community pharmacies in Australia. A mixed methods approach was used where barriers were identified by change facilitators during the implementation study. Change facilitators trialled and recorded tailored facilitation strategies delivered to overcome identified barriers. Barriers were coded according to implementation factors derived from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Tailored facilitation strategies were coded into 16 facilitation categories. To predict the effectiveness of these strategies, data mining with random forest was used to provide the highest level of accuracy. A predictive resolution percentage was established for each implementation strategy in relation to the barriers that were resolved by that particular strategy.ResultsDuring the 2-year programme, 1131 barriers and facilitation strategies were recorded by change facilitators. The most frequently identified barriers were a ‘lack of ability to plan for change’, ‘lack of internal supporters for the change’, ‘lack of knowledge and experience’, ‘lack of monitoring and feedback’, ‘lack of individual alignment with the change’, ‘undefined change objectives’, ‘lack of objective feedback’ and ‘lack of time’. The random forest algorithm used was able to provide 96.9% prediction accuracy. The strategy category with the highest predicted resolution rate across the most number of implementation barriers was ‘to empower stakeholders to develop objectives and solve problems’.ConclusionsResults from this study have provided a better understanding of implementation barriers in community pharmacy and how data-driven approaches can be used to predict the effectiveness of facilitation strategies to overcome implementation barriers. Tailored facilitation strategies such as these can increase the rate of real-time implementation of innovations in healthcare, leading to an industry that can confidently and efficiently adapt to continuous change.

Application of the PRECEDE-PROCEED model for the development of a community pharmacy ear health intervention for rural populations

Abstract Introduction The World Health Organisation has identified ear disease to be a major public health problem in rural and remote communities, with access to services an identified barrier. (1) Rural community pharmacists are recognised as highly skilled, accessible and trusted health professionals. An innovative service “LISTEN UP” (Locally Integrated Screening and Testing Ear aNd aUral Program) has been implemented in two remote community pharmacies in Australia. The service involves patients with an ear complaint self-presenting to a participating pharmacy and receiving a clinical examination by a pharmacist, who has completed accredited training in ear health, otoscopy and tympanometry. “LISTEN UP” has been developed using the PRECEDE-PROCEED planning model.(2) The PRECEDE component of the model assesses social, epidemiological, behavioural, environmental, educational and ecological factors to inform the development of an intervention.(2) The PROCEED-component consists of pilot testing and evaluation. Aim To describe an ecological approach to health promotion via the application of the PRECEDE-PROCEED planning model to develop a rural community pharmacy-based ear health intervention. Methods PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis) provided a framework to plan and develop a locally relevant and community focused program. This included research and engagement via meetings, surveys and interviews of consumers, pharmacists, health professionals and stakeholders. PROCEED (Policy, Regulatory, and Organisational Constructs in Educational and Environmental Development) outlined the structure for implementing and evaluating the intervention that was developed in the PRECEDE process. A pilot study has been included in PROCEED segment to allow improvement before implementing and evaluating the final model. Data will be collected in the pilot study via semi-structured interviews and surveys. This will be analysed using descriptive statistics and thematic analysis of qualitative data. Results As part of the PRECEDE segment a social assessment was undertaken via mixed method studies of rural consumers, pharmacists and health professionals. Hearing testing was ranked as the seventh (from twenty-six) most important expanded pharmacy service by both consumer and health professional groups. An epidemiological assessment found extensive ear disease in rural and remote locations resulting in complications and hearing loss. Behavioural and environment assessments identified eleven ear health interventions which include hearing screening [3], otoscopy pilot studies [2], audiometry services [1], specific education for undergraduate pharmacy students [2] and a pharmacy-based clinic [3]. However none of the interventions described a framework for continued service provision. Policy and regulation assessment was undertaken to align the intervention within the regulatory framework. The application of this model is partially complete with the study protocol for the intervention developed and the initial pilot study in progress. This study’s strengths include its applicability to rural populations and the limited evidence base that currently exists. It is however limited by the small size of the pilot study and application of this model to a national intervention would be useful for future. Conclusions The application of the PRECEDE-PROCEED model demonstrates the applicability of this planning model for developing and evaluating an ear health intervention with a particular focus on community pharmacies in rural and remote locations.

Community pharmacist interventions in ear health: a scoping review.

In Australia, around 3.6 million people suffer from hearing loss, more than 1.3 million with preventable hearing conditions. Ear diseases are prevalent in Indigenous populations, particularly children and are associated with poor educational outcomes and subsequent high rates of unemployment and incarceration. In Australia, rural and remote communities have rates of middle ear perforations five times the rate that the World Health Organisation regards to be a significant public health problem.Barriers to accessing ear health services have been identified including gaps in testing during the 'early years' and difficulty in accessing these services. Reducing the risk of hearing loss through improved ear health care can directly impact the ability to learn and develop. Collaboration between community, health providers and government is crucial to ensure necessary support for change. An opportunity presents for rural community pharmacists, who are both qualified and accessible to provide an ear health programme and thus improve health outcomes for both Indigenous and non-Indigenous Australians in their communities. The aim of this study was to identify published evidence of pharmacists' involvement in ear health care interventions to inform the development of ear health services able to be delivered in rural community pharmacy in Australia. The search strategy was applied to the following electronic databases: MEDLINE, Scopus, CINAHL, Emcare, Cochrane, Google Scholar and Google.Study selection articles were included if they described an ear health intervention in a community pharmacy setting. The interventions reported in the articles were evaluated for their inclusion of effectiveness, whether the service was sustainable, and the inclusion of enablers and barriers to the provision of ear care. The articles were also thematically analysed using the Deadly Ears Deadly Kids Deadly Communities Framework. A total 8427 articles were identified and evaluated against inclusion and exclusion criteria, with eleven eligible articles suitable for inclusion in the review. The articles included were conducted in Australia (n = 4), England (n = 4), United States of America (n = 2) and Brazil (n = 1). The ear health interventions identified included hearing screening (n=3), otoscopy pilot studies (n=2), audiometry services (n=1), specific education for undergraduate pharmacy students (n=2) and a pharmacy-based clinic (n=3). Effectiveness and sustainability were not formally reported in any of the included articles. Positive outcomes, funding availability, consumer access to community pharmacy, cost savings for consumers and improved connection to health providers were identified as enablers. Difficulty in attracting funding was the most commonly reported barrier. Improving ear health of both Indigenous and non-Indigenous peoples through services provided in community pharmacy presents as an important opportunity for rural pharmacists. Pharmacists are accessible and thus well placed to improve ear healthcare and resultant quality of life for these vulnerable populations. This review has identified factors required to effectively develop ear health models of care in community pharmacy including a pharmacist training program, continuous funding to ensure sustainability and support from pharmacy stakeholders and the community.

PNS70 Employment Preferences of Australian Pharmacists: Evidence from a Discrete Choice Experiment

The contribution of pharmacists to the development of a more efficient, productive and integrated healthcare system has been long discussed, mainly around the potential deployment of their clinical skills and knowledge to optimise medication use. When considering policy change in the pharmacy sector, understanding pharmacists’ preferences on different aspects of job opportunities when considering their career prospects is crucial. This paper aims to understand Australian pharmacists’ employment preferences using a discrete choice experiment. A labelled discrete choice experiments (DCE) was developed incorporating six key sectors of employment for pharmacy graduates: hospital pharmacy, community pharmacy, primary healthcare setting, pharmaceutical industry, government/academia, and non-pharmacy related sector. Each alternative is described by five attributes: role, flexible work schedule, career opportunities, geographic location, and annual salary. The DCE was embedded in the PAMELA (Pharmacy in Australia: Measuring Employment, Labour decisions, and Activity) survey, which was designed to investigate the employment preferences and work activities of Australian pharmacists. Generally hospital pharmacy was more desirable than pharmaceutical industry and non-pharmacy related sector while being less desirable than primary care settings. We also found that pharmacists significantly preferred higher annual salary than less and they preferred expanded roles in community pharmacy and primary care settings, of which the marginal willingness-to-pay values are about one third of pharmacists’ average annual salary. Our findings show that geographic location generally is the most important non-monetary job characteristics with the largest monetary values. Our findings has policy implications for the pharmacy workforce in terms of evidence on the willingness of the current pharmacist population to a reform of the integration of pharmacists in primary care network. We also provide some insights on what attracts PDHs to clinical and non-clinical sectors, which could be crucial in health workforce planning.

Nutrition and packaging characteristics of toddler foods and milks in Australia.

To analyse nutritional and packaging characteristics of toddler-specific foods and milks in the Australian retail food environment to identify how such products fit within the Australian Dietary Guidelines (ADG) and the NOVA classification. Cross-sectional retail audit of toddler foods and milks. On-pack product attributes were recorded. Products were categorised as (1) food or milk; (2) snack food or meal and (3) snacks sub-categorised depending on main ingredients. Products were classified as a discretionary or core food as per the ADG and level of processing according to NOVA classification. Supermarkets and pharmacies in Australia. A total of 154 foods and thirty-two milks were identified. Eighty percentage of foods were snacks, and 60 % of foods were classified as core foods, while 85 % were ultraprocessed (UP). Per 100 g, discretionary foods provided significantly more energy, protein, total and saturated fat, carbohydrate, total sugar and Na (P < 0·001) than core foods. Total sugars were significantly higher (P < 0·001) and Na significantly lower (P < 0·001) in minimally processed foods than in UP foods. All toddler milks (n 32) were found to have higher energy, carbohydrate and total sugar levels than full-fat cow's milk per 100 ml. Claims and messages were present on 99 % of foods and all milks. The majority of toddler foods available in Australia are UP snack foods and do not align with the ADG. Toddler milks, despite being UP, do align with the ADG. A strengthened regulatory approach may address this issue.

Expanded practice in rural community pharmacy in Australia: pharmacists’ perspectives

AbstractBackgroundPharmacists internationally have successfully expanded their role to provide service delivery to remote rural communities.AimThis study evaluated Australian rural community pharmacists’ perspectives of expanded services, to identify priorities, areas of concern, enablers and barriers to their implementation.MethodA self‐administered questionnaire was distributed to rural and remote Australian (all states and territories) pharmacists between September and December 2019; respondents were asked to rank health issues and the expanded pharmacy services that could potentially address these issues in their communities. Questions were also included to evaluate health service accessibility, skills/knowledge, workspace limitations, time and support for the implementation of these services. Potential associations between demographic factors and responses were also assessed.ResultsOf the 92 returned responses analysed, the top three heath concerns were: Mental health, Cardiovascular disease and Diabetes. Depression screening/referral, diabetes management and vaccinations were the top three areas rated for expanded services. There was agreement (90%; 83/92) that pharmacists had the skills and knowledge for implementation, while time and space were reported as barriers for 50% (46/92) and 25% (23/92) of pharmacists, respectively. The majority of the pharmacists (80%; 74/92) felt services were not easily accessible, and all (92/92, 100%) agreed that service provision would improve community health outcomes.ConclusionRural pharmacists were supportive of the delivery of expanded pharmacy services, describing improved health outcomes and increased access to health services as potential benefits. Successful implementation of these expanded services would require both an understanding of pharmacist resources available and local community health needs.

Health professional perspectives of expanded practice in rural community pharmacy in Australia.

Expanded pharmacy service delivery for rural and remote Australia has potential to address the rural health disparity. Pharmacists practising to their full scope are recognised as being most beneficial in rural and regional communities, where access to health professionals (HPs) is not comparable to those in metropolitan areas. However, research on HP perspectives on expanded pharmacy practice is limited. This study aims to determine rural and remote HP (doctors, nurses, allied health and other HPs) perspectives of expanded services to be delivered through community pharmacy. Australian rural and remote HPs participated in a questionnaire survey which explored views on expanded pharmacy services in their local communities. Potential expanded pharmacy services were provided, and participants were asked to indicate what expanded pharmacy would benefit their local community and their level of support for the services. Analysis of the data included frequency analyses and one-way ANOVA tests with post hoc Tukey's HSD tests using IBM SPSS Statistic 25. Health professionals (N=121) from rural and remote locations participated. Sexually transmitted disease testing, vaccinations, diabetes and asthma management were the most frequently chosen services that HPs agreed would improve the health of people in their community. Doctors chose the least number of services (mean=1 services) compared with all other HPs (mean=>5 services). Sixty-eight per cent of participants agreed/strongly agreed that providing these additional services would improve health, with participants (73%) agreeing/strongly agreeing that they would support the implementation of these additional services, not otherwise available in their community. Comparing professional groups, doctors were only half as supportive of expanded pharmacy services, when compared with all other HPs. This study confirms the importance of a collaborative, local model to deliver expanded pharmacy services for rural communities. Health professionals were found to largely support expanding pharmacy practice, agreeing about the improved access to health care that would be provided for people living in rural and remote Australia.

Changes in sales of analgesics to pharmacies after codeine was rescheduled as a prescription only medicine.

To investigate changes in sales to pharmacies of over-the-counter (OTC) and prescription analgesics, cold and flu products, and cough suppressants after the rescheduling of codeine as a prescription only medicine in February 2018. Interrupted time series analysis of sales to pharmacies. Pharmaceutical sales to community pharmacies in Australia, March 2015 - March 2019. The period January 2017 (month after rescheduling was announced) to January 2018 (month before rescheduling was implemented) was excluded from the time series analysis. Monthly pack and tablet sales per 10000 population of OTC and prescription analgesics, cold and flu products, and cough suppressants. During 2016, 7586 packs and 248127 tablets of OTC codeine per 10000 population were sold to pharmacies; in the 14 months after rescheduling, a small level increase in monthly prescription codeine sales was evident (2247 tablets/capsules per 10000 population; 95% CI, 1231-3264 per 10 000 population). Monthly OTC analgesic sales increased by 258 (95% CI, 151-365) packs per 10000 population and 37856 (95% CI, 26143-49569) tablet/capsules per 10000 population. Monthly sales of single ingredient paracetamol (41415 [95% CI, 31374-51456] tablets/capsules per 10000 population), ibuprofen (1392 [95% CI 916-1868] tablets/capsules per 10000 population), paracetamol/ibuprofen (1618 tablets [95% CI, 1567-1669] tablets/capsules per 10000 population), and other paracetamol combinations (233 [95% CI, 112-353] tablets/capsules per 10000 population) all increased, but not those of prescription analgesic products not containing codeine. Rises for OTC cold/flu products containing the opioid derivative dextromethorphan were small; sales of OTC cough suppressants containing opioid derivatives (dextromethorphan, pholcodine, dihydrocodeine) did not change. The rescheduling of codeine was followed by increased sales to pharmacies of paracetamol, ibuprofen, and paracetamol combination products. While these products carry no risk of dependence, their inappropriate use is also associated with harms that warrant adverse event monitoring.

Community pharmacy naloxone supply, before and after rescheduling as an over-the-counter drug: sales and prescriptions data, 2014-2018.

To characterise the community pharmacy supply of naloxone by supply type - individual prescription, prescriber bag, and non-dispensed (supplied over the counter or expired) - during 2014-2018; to examine whether the 2016 rescheduling of naloxone as an over-the-counter drug influenced non-dispensed naloxone supply volume. Analysis of monthly naloxone prescriptions (Pharmaceutical Benefits Scheme) and sales data (IQVIA), 2014-2018, for Australia and by state and territory; time series analysis of non-dispensed naloxone supply to assess effect of rescheduling on naloxone supply. Total naloxone supply to community pharmacies; prescribed and non-dispensed naloxone supply. During 2014-2018, 372351 400μg units of naloxone were sold to community pharmacies: non-dispensed naloxone accounted for 205866.5 units (55.3%), prescriber bags for 155841 units (41.8%), and individual prescriptions for 10643.5 units (2.9%). Population-adjusted national naloxone sales to community pharmacies increased between 2014 and 2018 (per year: incidence rate ratio [IRR], 1.15; 95% CI, 1.09-2.22). This increase was primarily attributable to increased volumes of prescriber bag naloxone (IRR, 1.63; 95% CI, 1.50-1.78) and, to a lesser extent, increased individual prescription supply (IRR, 2.04; 95% CI, 1.85-2.26). Non-dispensed naloxone supply volume was unchanged at the national level (IRR, 0.93; 95% CI, 0.85-1.01); changes in non-dispensed supply immediately following rescheduling and subsequently were not statistically significant in time series analyses for most jurisdictions. Total naloxone supply to community pharmacies in Australia increased between 2014 and 2018, but rescheduling that enabled over-the-counter access did not significantly influence the volume of non-dispensed naloxone.

Performance-based pharmacy payment models: the case for change.

In response to rising healthcare costs, healthcare payers across the globe have been experimenting with performance-based payment models that link payments to providers with the quality of care that they provide. Community pharmacy in Australia has yet to be significantly affected by these changes. Initial steps have been taken to fund quality-linked interventions by pharmacists, such as the provision of medicines in dose administration aids, but funding for dispensing prescriptions remains solely based on a fee-for-service model. At the foundation of any performance-based payment model are measures that, in aggregate, reflect the quality of care that is provided. Patient adherence to prescription regimens can be correlated with the counselling provided by pharmacists and, as such, can serve as the measure on which a performance-based payment model for dispensing can be constructed. Experience in the US suggests per-prescription payments to a pharmacy can be increased or decreased by a small, yet meaningful, amount based on a measure of the level of adherence of patients of the pharmacy. The current dispensing payment model in the Australian Pharmaceutical Benefits Scheme may be able to be modified in a similar manner to support provision by pharmacists of improved quality of care.

Pharmacist perspectives towards pharmaceutical care services in neonatal intensive care units in Australia and Poland

The purpose of this study was to, first, investigate the perceptions of neonatal intensive care unit (NICU) pharmacists and directors of pharmacy in Australia and Poland regarding their level of preparation to perform pharmaceutical care services in the NICU, and second, identify practice barriers and ways to improve services. A cross-sectional, electronic-based survey was distributed among NICU pharmacists and directors of pharmacy working in hospitals with a NICU in Australia and Poland. The survey comprised 12 items, and the majority of questions were fixed binary ‘agree/disagree’ answers, supplemented by open-ended questions. A total of 29 participants from Australia and 20 from Poland completed the survey. Overall, it is apparent that Australian pharmacists felt more competent in clinical and educational roles than Polish participants. For 14 of the 15 clinical roles listed, more than 70% of Australian participants felt that pharmacists had a ‘good’ level of preparation to provide services to the NICU, including performing medication chart reviews (93.1%) and pharmaceutical interventions (96.6%), and collaborating with medical and nursing staff (93.1%). A significantly higher proportion of Polish than Australian pharmacists agreed that changes were needed to improve pharmacist practice in the NICU (90 vs. 53.6%; p = 0.007). Future efforts should focus on developing guidelines and practice standards for sub-specialties of pharmacist practice, such as neonatology, to promote the standardization of practice.

Australian Pharmacists' Perceptions and Practices in Travel Health.

Worldwide, pharmacists are playing an increasing role in travel health, although legislation and funding can dictate the nature of this role, which varies from country to country. The aim of this study was to explore the current and potential future practices in travel health for pharmacists in Australia, as well as the perceived barriers, including training needs, for the provision of services. A survey was developed and participation was sought from a representative sample of Australian pharmacists, with descriptive statistics calculated to summarise the frequency of responses. A total of 255 participants, predominantly female (69%), below 50 years (75%) and registered less than 30 years completed the survey. Although over two-thirds (68%) provided travel-related advice in their current practice, the frequency of advice provision was low (less than 2 travellers per week) and limited to responding to travellers questions. Although Australian pharmacists are currently unable to administer travel vaccines and prescription only medications without prescription, they still consider travel health to be an appropriate role and that their clients would seek travel health advice from pharmacies if offered. Currently, key roles for Australian pharmacists are advising travellers who do not seek advice from other practitioners, reinforcing the advice of other health practitioners and referring travellers needing vaccinations and antimalarials. In order to expand these services, the barriers of workload, time, staffing and the need for training in travel health need to be addressed. In summary, the travel health services provided by pharmacies in Australia still have a way to go before they match the services offered by pharmacies in some other countries, however Australian pharmacist are keen to further develop their role in this area.