Elizabeth Hotham

Community pharmacists in Australia: barriers to information provision on complementary and alternative medicines.

ObjectiveTo determine, by surveying Australian community pharmacists, the perceived barriers to the provision of information about complementary and alternative medicines (CAMs) and suggestions for overcoming them.MethodAnonymous, self-administered survey sent to a random sample of 701 pharmacists registered in three states of Australia in 2004.Main outcome measurePharmacists’ perceived barriers to the provision of information about CAMs.ResultsA total of 344 questionnaires were returned by pharmacists (49% response) of which 211 (30%) were currently practising in community pharmacy. Ninety-five percent of surveyed community pharmacists indicated that they personally received enquires about CAMs, with fewer than 15% reporting they were “very confident” in answering queries about safety, interactions or benefits of CAMs. Frequently used CAM information sources were those from manufacturers and distributors, professional newsletters and journals and textbooks. Pharmacists’ perceived barriers to the provision of CAM information included a lack of suitable training (most training was informal), deficiencies in available information sources, a lack of managerial support, the need for regulatory changes, consumer beliefs about CAM safety and time constraints due to competing demands in daily practice. Pharmacists proposed improvements to overcome these barriers including improvements to training.ConclusionThere is scope for pharmacy professional organisations and educational institutions to further support pharmacists in their practice through providing information on the best information sources available and training that meets the needs of undergraduate students, pharmacists and other pharmacy staff. There is a need to examine regulatory requirements concerning the provision of product information with CAMs in Australia and to implement mechanisms for increasing consumer awareness of regulatory procedures for these medicines.

Pregnancy-related changes in tobacco, alcohol and cannabis use reported by antenatal patients at two public hospitals in South Australia.

Background: Australian substance use data do not demonstrate pregnancy‐related changes or distinguish between pregnant and lactating women.

Treatment experiences of children and adolescents with attention-deficit/hyperactivity disorder

Aim:  To gain insight into the treatment experiences of children and adolescents diagnosed with attention‐deficit/hyperactivity disorder (ADHD).

Exploring the dissonance between business and public health policy: pharmacy and the provision of opioid pharmacotherapies and clean needles in rural settings

Objective To ascertain, by interview of rural community pharmacists, how well public health policies relating to the provision of clean needles and opioid pharmacotherapies fit with the imperatives of business. Previous research investigating the provision of opioid pharmacotherapies focused predominantly on metropolitan community pharmacists and their experience with servicing methadone clients. Furthermore, there had been no exploration as to whether dissonance exists between community pharmacy business imperatives and the public health policy underpinning these programmes.

Investigation of the Alcohol, Smoking, and Substance Involvement Screening Test (the ASSIST) Version 3.0 in Pregnancy

Objectives: To investigate the utility of the World Health Organization’s Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) Version (V) 3.0 for identifying substance use disorders in pregnancy. Methods: ASSIST V3.0’s performance was assessed, focussed on nicotine, alcohol, and cannabis, using a 2-pronged harm categorization: risk to the woman as an individual and risk to the fetus. For the former, risk levels concordant with general population cut-points were utilized. A total of 104 substance users in an Australian public maternity hospital were identified by case-note audit. The ASSIST V3.0 scores were appraised against the scores for established tools—tobacco: the Revised Fagerstrom Tolerance Questionnaire, alcohol: the tolerance, annoyed, cut down, eye-opener, and cannabis: the Timeline FollowBack. Results: Kappa analyses of Specific Substance Involvement Scores for ASSIST V3.0 did not support changing cut-points for the woman as an individual; however, receiver operating characteristics curves delineated an Specific Substance Involvement Scores of 4 as indicative of fetal risk for both alcohol and cannabis. All nicotine users (98 of the 104 participants) were “at high risk”; hence a cut-point indicative of fetal risk for nicotine could not be determined. Conclusions: The role of the ASSIST V3.0 is uncertain for this population. Given the predominance of nicotine use, nicotine use screening could be the primary focus, with follow-up screening for alcohol and other substances if tobacco use were identified; there may be a place for a restructured ASSIST in that context. Positive screening results should be followed by ongoing counseling support throughout pregnancy, with the intensity dictated by the severity of use.

Views of obstetric practitioners and hospital pharmacists on Therapeutic Goods Administration approved Product Information for pregnancy and lactation

This study investigated views and experiences of over 40 health professionals regarding pregnancy and lactation advice in Australian Product Information (PI). Quality up‐to‐date information is required when prescribing medication to this demographic. It was found that reliance on PI can result in negative ramifications. These interviews amplify earlier, somewhat limited evidence that PI recommendations are likely overconservative, outdated and unreflective of clinical practice in this field.

South Australian rural community pharmacists and the provision of methadone, buprenorphine and injecting equipment

Objective To explore how the provision of opioid substitution treatment (OST) services and/or sterile injecting equipment impacts on community pharmacists. This will assist in identifying strategies to improve the provision of maintenance pharmacotherapy treatment programmes in South Australia.

Counting the cost of over-the-counter codeine containing analgesic misuse: A retrospective review of hospital admissions over a 5 year period

INTRODUCTION AND AIMS Combination analgesics containing codeine (CACC) are currently available over-the-counter (OTC) in many countries following a pharmacists advice. Published case reports detail life-threatening morbidities associated with OTC-CACC misuse, although the cost of treating such patients has not been quantified. This study aims to: (i) identify and detail patients admitted to an Australian tertiary teaching hospital over a 5 year period with sequelae of OTC-CACC misuse; and (ii) estimate the costs of identified hospital admissions. DESIGN AND METHODS Using International Classification of Diseases (10th revision) diagnostic codes, a structured search was performed to identify admissions to a tertiary teaching hospital, relating to CACC misuse, over the defined period. A retrospective case note review provided data detailing patient characteristics, presenting morbidities and resultant interventions, and an approximate cost was calculated for identified admissions. RESULTS Ninety-nine OTC-CACC-related admissions (for 30 individual patients) were identified. Most related to gastrointestinal morbidities secondary to ibuprofen/codeine misuse. Mean length of stay per admission was 5.9 days, with 10.1% of admissions requiring intensive care. Patients consumed a daily mean of 28 OTC-CACC tablets for a mean of 606 days prior to admission. These 99 admissions were estimated to cost the health system AU

Pregnancy and lactation advice: How does Australian Product Information compare with established information resources?

1 008 082 with a mean cost per admission of AU

Pharmacogenomics and Patient Treatment Parameters to Opioid Treatment in Chronic Pain: A Focus on Morphine, Oxycodone, Tramadol, and Fentanyl

10 183. DISCUSSION AND CONCLUSIONS The outcomes of OTC-CACC misuse are serious and come at a significant cost to patient health and the Australian health-care system. Identification and management of this cohort appears sub-optimal with delays in diagnosis and high readmission rates.