An Advanced Pharmacy Practice Framework for Australia

The need to develop An Advanced Pharmacy Practice Framework for Australia (the “APPF”) was identified during the 2010 review of the competency standards for Australian pharmacists. The Advanced Pharmacy Practice Framework Steering Committee, a collaborative profession-wide committee comprised of representatives of ten pharmacy organisations, examined and adapted existing advanced practice frameworks, all of which were found to have been based on the Competency Development and Evaluation Group (CoDEG) Advanced and Consultant Level Framework (the “CoDEG Framework”) from the United Kingdom. Its competency standards were also found to align well with the Domains of the National Competency Standards Framework for Pharmacists in Australia (the “National Framework”). Adaptation of the CoDEG Framework created an APPF that is complementary to the National Framework, sufficiently flexible to customise for recognising advanced practice in any area of professional practice and has been approved by the boards/councils of all participating organisations. The primary purpose of the APPF is to assist the development of the profession to meet the changing health care needs of the community. However, it is also a valuable tool for assuring members of the public of the competence of an advanced practice pharmacist and the quality and safety of the services they deliver.

Australian pharmacists' self-perceptions in relation to the 'Advanced Pharmacy Practice Framework'

Background The Australian Pharmacy Practice Framework was developed by the Advanced Pharmacy Practice Steering Committee and endorsed by the Pharmacy Board of Australia in October 2012. The Steering Committee conducted a study that found practice portfolios to be the preferred method to assess and credential Advanced Pharmacy Practitioner, which is currently being piloted by the Australian Pharmacy Council. Credentialing is predicted to open to all pharmacists practising in Australia by November 2015. Objective To explore how Australian pharmacists self-perceived being advanced in practice and how they related their level of practice to the Australian Advanced Pharmacy Practice Framework. Method This was an explorative, cross-sectional study with mixed methods analysis. Advanced Pharmacy Practice Framework, a review of the recent explorative study on Advanced Practice conducted by the Advanced Pharmacy Practice Framework Steering Committee and semi-structured interviews (n = 10) were utilized to create, refine and pilot the questionnaire. The questionnaire was advertised across pharmacy-organizational websites via a purposive sampling method. The target population were pharmacists currently registered in Australia. Results Seventy-two participants responded to the questionnaire. The participants were mostly female (56.9%) and in the 30–40 age group (26.4%). The pharmacists self-perceived their levels of practice as either entry, transition, consolidation or advanced, with the majority selecting the consolidation level (38.9%). Although nearly half (43.1%) of the participants had not seen the Framework beforehand, they defined Advanced Pharmacy Practice similarly to the definition outlined in the Framework, but also added specialization as a requirement. Pharmacists explained why they were practising at their level of practice, stating that not having more years of practice, lacking experience, or postgraduate/post-registration qualifications, and more involvement and recognition in practice were the main reasons for not considering themselves as an Advanced Pharmacy Practitioner. To be considered advanced by the Framework, pharmacists would need to fulfill at least 70% of the Advanced Practice competency standards at an advanced level. More than half of the pharmacists (64.7%) that self-perceived as being advanced managed to fulfill 70% or more of these Advanced Practice competency standards at the advanced level. However, none of the self-perceived entry level pharmacists managed to match at least 70% of the competencies at the entry level. Conclusion Participants' self-perception of the term Advanced Practice was similar to the definition in the Advanced Pharmacy Practice Framework. Pharmacists working at an advanced level were largely able to demonstrate and justify their reasons for being advanced practitioners. However, pharmacists practising at the other levels of practice (entry, transition, consolidation) require further guidance regarding their advancement in practice.

Australia’s first Pharmacists Immunisation Pilot – about the service

Background: The first phase of the Queensland Pharmacist Immunisation Pilot (QPIP) ran between April and August 2014, to pilot pharmacists administering influenza vaccinations for the flu season for the first time in Australia. Aim: An aim was to investigate factors facilitating implementation of a pharmacist vaccination service in the community pharmacy setting. Method: The QPIP pharmacies were divided into two arms; the South East Queensland arm consisting of 51 Terry White Chemists (TWCs), and 29 pharmacies in the North Queensland (NQ) arm. The TWCs featured pharmacies which previously provided a vaccination service and that were experienced with using an online booking system, providing an opportunity to capture booking data. Results: The TWCs delivered 9902 (90%) of the influenza vaccinations in QPIP. Of these, 48.5% of the vaccines were delivered via appointments made using the online booking system, while 13.3% were in-store bookings. Over one-third (38.2%) of the vaccinations delivered in were “walk-ins” where the vaccination was delivered ‘on the spot’ as spontaneous or opportunistic vaccinations. The absence of a booking system meant all vaccinations delivered in the NQ arm were “walk-ins”. The online-booking data showed 10:00 am and Tuesday being the most popular time and day for vaccinations. Patients preferred having their vaccinations in private consultation rooms, over areas which used a screen to partition off a private area. Discussion: The presence of an online booking system appeared to increase the efficiency and penetration of the of vaccine service delivery. Also, as the level of privacy afforded to patients increased, the number of patients vaccinated also increased. Conclusions: As pharmacist-delivered vaccination services start to progressively roll out across Australia; these findings pave the way for more efficient and effective implementation of the service.

Metformin for the pain in your backside?

Pain is a sensation that most people feel at some time-be it when we accidently stub our toe, or burn our hand when reaching into the oven to pull out that souffle left baking for too long.

Raloxifene for improving attention and memory in schizophrenia?

Schizophrenia can affect people's thoughts, feelings, and behaviour, and it can be as if your brain was playing tricks on you.

Rituximab for chronic fatigue syndrome?

Most people complain about being tired and wish they could sleep in for a few more hours instead of going to work. However, 'being tired' has a whole different meaning for people living with chronic fatigue syndrome, which is also known as myalgic encephalomyelitis.

Design challenges for electronic medication administration record systems in residential aged care facilities: A formative evaluation

Introduction Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements. Methods A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system. Results The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues.We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows. Discussion Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use.

Who does nutrition prevention work in Queensland? An investigation of structural and political workforce reforms

- Aim This study aimed (i) to determine the change in the number of government-funded nutrition positions following structural and political reforms and (ii) to describe the remaining workforce available to do nutrition prevention work, including student placements, in Queensland. - Methods Positions funded by the Queensland government were counted using departmental human resource data and compared with data collected 4 years earlier. Positions not funded by the government were identified using formal professional networks and governance group lists. Both groups were sent an online survey that explored their position name, funding source, employer, qualifications, years of experience, work in prevention and ability to supervise students. - Results There was a 90% reduction in the number of nutrition prevention positions funded by the government between 2009 (137 full time equivalents (FTE)) and 2013 (14 FTE). In 2013, 313 specialist (n = 92) and generalist (n = 221) practitioners were identified as potentially working in nutrition prevention throughout Queensland. A total of 30 permanent FTEs indicated over 75% of their work focused on prevention. This included the 14 FTE funded by the Queensland government and an additional 16 FTE from other sectors. Generalists did not consider themselves part of the nutrition workforce. - Conclusions Queensland experienced an extreme reduction in its nutrition prevention workforce as a result of political and structural reforms. This disinvestment by the Queensland government was not compensated for by other sectors, and has left marked deficits in public health nutrition capacity, including student placements.

Making decisions about antibiotic use in the Australian primary healthcare sector

Background Australia has one of the highest rates of antibiotic use amongst OECD countries. Data from the Australian primary healthcare sector suggests unnecessary antibiotics were prescribed for self-resolving conditions. We need to better understand what drives general practitioners (GPs) to prescribe antibiotics, consumers to seek antibiotics, and pharmacists to fill repeat antibiotic prescriptions. It is also not clear how these individuals trade-off between the possible benefits that antibiotics may provide in the immediate/short term, against the longer term societal risk of antimicrobial resistance. This project investigates what factors drive decisions to use antibiotics for GPs, pharmacists and consumers, and how these individuals discount the future. Methods Factors will be gleaned from published literature and from semi-structured interviews, to inform the development of Discrete Choice Experiments (DCEs). Three DCEs will be constructed – one for each group of interest – to allow investigation of which factors are more important in influencing (a) GPs to prescribe antibiotics, (b) consumers to seek antibiotics, and (c) pharmacists to fill legally valid but old or repeat prescriptions of antibiotics. Regression analysis will be conducted to understand the relative importance of these factors. A Time Trade Off exercise will be developed to investigate how these individuals discount the future. Results Findings from the DCEs will provide an insight into which factors are more important in driving decision making in antibiotic use for GPs, pharmacists and consumers. Findings from the Time Trade Off exercise will show what individuals are willing to trade for preserving the miracle of antibiotics. Conclusion Research findings will contribute to existing national programs to bring about a reduction in inappropriate use of antibiotic in Australia. Specifically, influencing how key messages and public health campaigns are crafted, and clinical education and empowerment of GPs and pharmacists to play a more responsive role as stewards of antibiotic use in the community.

Prey of the silver-headed antechinus (Antechinus argentus), a new species of Australian dasyurid marsupial

The silver-headed antechinus (Antechinus argentus) is one of Australia’s most recently described mammals, and the single known population at Kroombit Tops in south-east Queensland is threatened. Nothing is known of the species’ ecology, so during 2014 we collected faecal pellets each month (March–September) from a population at the type locality to gather baseline data on diet composition. A total of 38 faecal pellets were collected from 12 individuals (eight females, four males) and microscopic analysis of pellets identified seven invertebrate orders, with 70% combined mean composition of beetles (Coleoptera: 38%) and cockroaches (Blattodea: 32%). Other orders that featured as prey were ants, crickets/grasshoppers, butterflies/moths, spiders, and true bugs. Given that faecal pellets could only be collected from a single habitat type (Eucalyptus montivaga high-altitude open forest) and location, this is best described as a generalist insectivorous diet that is characteristic of other previously studied congeners.

Vaccination status of Australian community pharmacy

From the moment Queensland's Chief Health Officer, Dr Jeannette Young, laid down the gauntlet to Queensland pharmacists kicking off the Queensland Pharmacists Immunisation Pilot (QPIP) for the 2014 influenza season, community pharmacy in Australia was never going to be the same.