Issue 9/22 | May 5th, 2022
Contents:
News & Updates
Aged Care Scholarships: Allied Health Postgraduate
News & Updates
The 2021-22 budget measure – Growing a Skilled and High Quality Workforce to Care for Senior Australians, announced $26.154 million to invest in and grow a skilled aged care workforce, which will provide high quality care to senior Australians.
These scholarships will allow for up to 400 additional scholarships per year for three years, for personal care workers and nurses to complete qualifications. There will be up to 100 allied health scholarships per year for up to three years, which will be for allied health professionals to focus on dementia related qualifications.
Click HERE for further information and to apply. Applications close 12 May.
News & Updates
Consultation open on new psychotropic guidance
News & Updates
Aged care organisations and staff are encouraged to provide feedback on new clinical practice guidelines that aim to support the appropriate use of psychotropic medications for aged care residents with dementia.
The draft guidelines – which include 14 conditional recommendations and 44 good practice statements related to the appropriate use of antipsychotics, benzodiazepines, and antidepressants – are open for public consultation until the end of next week.
Five aged care organisations in four states have participated in the two-year project, which is led by Monash University’s Centre for Medicine Use and Safety (CMUS). The project, which is funded by the Dementia Centre for Research Collaboration, is in response to the high use of psychotropic medications in residential aged care and the royal commission’s interim report recommendations to avoid chemical restraints.
CMUS director and guideline clinical chair Professor Simon Bell said the guidelines targeted medical practitioners and senior clinical staff including registered nurses and pharmacists.
“The guidelines recognise that prescribers, pharmacists and aged care providers, including nurses and aged care staff, all have responsibilities in relation to facilitating the quality use of medicines,” Professor Bell told Australian Ageing Agenda. “We certainly appreciate their input into the recommendations.”
The resource focuses on antipsychotics, benzodiazepines, and antidepressants because most concerns raised relate to these medication classes. It also first of all recognises that psychotropic medications are not the preferred management option for changed behaviours, Professor Bell said.
“So it’s important that the guidelines are read in conjunction with other resources,” he said. “However, the guideline outlines the importance of, for example, facilitating active involvement of people living with dementia in decision-making in relation to medications. It also outlines some of the requirements for monitoring treatment effectiveness and adverse events. It also presents different antipsychotic and other psychotropic medication discontinuation strategies.”
The 18-member development group included geriatricians, clinical pharmacologists, pharmacists, nurses, experts in knowledge translation, experts in Indigenous and migrant health, aged care provider representatives, and a general practitioner, psychiatrist, legal practitioner, health economist, physiotherapist, and carers of people with dementia.
“The guidelines have been developed using an integrated knowledge translation approach,” Professor Bell said. “We’ve been very conscious to develop recommendations and good practice statements that are relevant to the aged care sector.”
The guidelines will be supported by a companion guide, fact sheets about antipsychotics, benzodiazepines and antidepressants, and a co-designed implementation and dissemination plan.
“The final materials are due to be released later this year,” Professor Bell said. “Following the release of the guidelines, we’ll also be working on a number of guideline implementation projects in partnership with different aged care providers. And part of that is working to ensure that the guidelines can be most effectively implemented in practice.”
The public consultation on the draft guidelines closes on Friday 6 May.
https://www.australianageingagenda.com.au/clinical/consultation-open-on-new-psychotropic-guidance/?utm_medium=email&utm_campaign=AAA%20290422&utm_content=AAA%20290422+CID_2fee6daa2eb000685f425ed2603f5e60&utm_source=Campaign%20Monitor&utm_term=Consultation%20open%20on%20new%20psychotropic%20guidance
(Note that the AACP has been advised that feedback on the guidelines will continue to be accepted until early June 2022)
News & Updates
NPS MedicineWise calls for review of quality use of medicines funding decision
News & Updates
NPS MedicineWise is calling for a review of the decision, announced in the Federal Budget, to change the way Quality Use of Medicines (QUM) initiatives are led and funded in Australia.
NPS MedicineWise was established in 1998 as an independent organisation to promote the quality use of medicines, supporting Australians to make safe and wise decisions about medicines and other health technologies. For 24 years, its activities have been primarily funded by the Commonwealth Government as a critical implementation arm for the National Medicines Policy.
From 1 January 2023, NPS MedicineWise will no longer receive uncontested funding from the Department of Health to deliver QUM functions. The Australian Commission on Safety and Quality in Health Care (ACSQHC) will take on core QUM ‘stewardship’ functions while education programs for health professionals and consumers will move to contestable funding.
Since its establishment, NPS MedicineWise has delivered a comprehensive set of medicines-related education programs and resources that have been shown to significantly improve health outcomes for Australians, such as reducing cancers, strokes, other major cardiovascular events and harm from opioid medicines. At the same time the organisation has delivered a net return on investment of more than 2:1 to the Government through over $1.1 billion in direct savings for the Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Scheme (MBS).
“Through 24 years of investment, NPS MedicineWise has built a unique set of expertise, assets and networks that is dedicated to supporting quality use of medicines and medicines safety, Australia’s 10th National Health Priority Area,” says Katherine Burchfield, CEO of NPS MedicineWise.
“We have a central focus on quality use of medicines, and are a trusted, 'go to’ resource and independent voice that is highly valued by consumers and frontline health professionals, particularly GPs. Our value and impact comes from our independence from any particular health professional discipline, and government. Benefits to consumers are central to our work and we achieve this using our expertise in behaviour change, bringing education, information and insights together to support evidence-based decision making across all health professional groups and health conditions”.
The changes come at a time when the need for a safe and wise use of medicines is increasing in importance, and while the guiding policy, the National Medicines Policy, is under review. The Royal Commissions into the aged and disability sectors have identified significant quality use of medicines issues, and stakeholders have been calling for a stronger focus on QUM, and continuation of independent QUM stewardship. Although the Government has announced an increase in funding for quality use of medicines in 2022-23, much of this is to support the transition, and it is not clear whether current levels of investment will be maintained in future years.
Functions that are expected to transfer from NPS MedicineWise to the ACQSHC include national stewardship and indicators, the MedicineInsight dataset, the MedicineWise consumer apps and the NPS MedicineWise website and content.
“While there is no doubt that the ACSQHC has a key role to play in quality use of medicines, and has strong capabilities and networks, it performs a different role and function in the health system to that of NPS MedicineWise. The two organisations should work together, using their different strengths and levers, to enact change,” says Katherine Burchfield.
Reducing duplication and introducing an element of contestable funding in delivery of programs are excellent goals. However, when taken all together, the changes that have been announced risk fragmentation and dilution of effort at a time when Australians most need a strong, integrated approach around quality use of medicines.
A 2019 Government-led Review of the organisation found almost universal acknowledgement that NPS MedicineWise’s activities should continue to be supported by the Commonwealth.
“It is not clear why this decision was made at this time, in this way, without consultation, given its importance to so many people and to the wider sector.”
NPS MedicineWise has other funding sources and will look to continue its operations beyond 31 December 2022. However, it will not have the remit or funding to continue in its current form.
Katherine Burchfield says, “Having listened to voices from across the health and aged care sectors, we are calling for a review of the Federal budget decision, with in-depth consultation before these changes are implemented”
News & Updates
South Australian accredited pharmacist Kylie Van Rooijen talks about her roles
News & Updates
Recently announced as Pharmaceutical Society of Australia (PSA) SA South Australian Pharmacist of the Year, Kylie has shared some details with the AACP about her important roles.
Kylie is based in Port Lincoln, a town on the Lower Eyre Peninsula in SA. It is the largest city in the West Coast region and is located approximately 280 km as the crow flies from Adelaide but is 646 km away by road. It has a population of approximately 15,000 people.
Kylie has been involved in the PSA project which embedded pharmacists in GP practices and Aged Care facilities. During her time with the project, she completed the AACP accreditation assessment and achieved accreditation in June 2021. She says that the AACP process ‘taught me a lot.’ Kylie also completed her credentialling as a diabetes educator, adding that ‘at a time, I thought would be the twilight of my career, [it] has become the most interesting and fulfilling.’
In addition to these roles, Kylie also works at Port Lincoln Aboriginal Health Service, which she says is ‘varied and interesting.’
Part of her role involves Professional Practice and Clinical Governance activities, such as reviewing and updating clinical procedures and reviewing clinical incidents and near misses. She and the team she works with are currently planning future services with clinic activities designed to meet the local community needs as well as improving transitions of care.
Kylie also conducts medication management reviews, consulting with community and hospital pharmacies constantly trying to reconcile medication lists.
She has also worked in vaccination clinics and continues to organise immunisation drives for COVID-19 vaccines.
As rules relating to home visits are relaxed, Kylie has commenced home visits as a diabetes educator, sitting in kitchens explaining glucometer use and advising on the correct storage of insulin.
Kylie’s achievements are an inspiration to all pharmacists, and she is a well deserving winner of this award. She states that ‘Every day is interesting and varied. It’s a terrific time to be a pharmacist.’
News & Updates
Women & Leadership Scholarships 2022
News & Updates
Women & Leadership Australia (WLA) is currently offering professional development scholarships for Australian Association of Consultant Pharmacy staff and members. The scholarships are open to women across all areas of the Health Sector, and we encourage you to share this opportunity with your staff & members.
Women & Leadership Australia supports women leaders across all sectors and industries by providing world-class leadership development programs for emerging, middle and senior leaders. Our career-defining leadership programs bring together a focus on applied learning with the latest in leadership theory & practice. We believe that advancing gender equity, especially in leadership, is central to creating a more fair and inclusive society.
Through our Industry Partnership Framework, we work with over 500 associations and professional bodies to increase awareness and action around gender equity. With your support, we can continue to create meaningful opportunities for women leaders in your industry.
Scholarships of $1000 - $5000 per person available for women in the Health Sector
- To encourage more women to step into leadership roles across the Health Sector, WLA is offering scholarships for 4 x leadership development courses. Apply by 10 June or find out more by clicking here - https://www.wla.edu.au/health.html
To help you share this information easily across any platform your members engage with, we have created a suite of social media titles, images, program reviews and wording that you can access via this Dropbox link: Here
We know that support from associations like yours makes a significant difference to the number of women who are able to access high quality leadership development. We appreciate your assistance and look forward to supporting more women leaders across the country.
News & Updates
MIMS Monthly Update May 2022
News & Updates
New Products
- Elotuzumab (Empliciti) is an immunostimulatory humanised, IgG1 monoclonal antibody that specifically targets the SLAMF7 (signaling lymphocyte activation molecule family member 7) protein. SLAMF7 is highly expressed on multiple myeloma cells independent of cytogenetic abnormalities. Elotuzumab targets SLAMF7 on myeloma cells and facilitates the interaction with natural killer cells (via Fc receptors) to mediate the killing of myeloma cells through antibody-dependent cellular cytotoxicity (ADCC). Elotuzumab also directly activates natural killer cells through the SLAMF7 pathway to enhance anti-myeloma activity in vitro. Empliciti is indicated in combination with lenalidomide and dexamethasone for the treatment of patients with multiple myeloma who have received at least one prior therapy. Empliciti is used in combination with other medicinal products; therefore, the contraindications applicable to those medicinal products also apply to Empliciti combination therapy. Empliciti powder for infusion contains elotuzumab 300 mg or 400 mg and is available in pack sizes of 1 single use vial.
- Paliperidone (as palmitate) (Invega Hafyera) is a psychotropic agent belonging to the chemical class of benzisoxazole derivatives (atypical neuroleptic antipsychotic). Paliperidone is a centrally active dopamine Type 2 (D) receptor antagonist and a serotonin Type 2 (5HT2A) receptor antagonist. Paliperidone is also active as an antagonist at α1 and α2 adrenergic receptors and H1 histaminergic receptors, which may explain some of the other effects of the drug. Invega Hafyera, a 6-month injection, is indicated for the maintenance treatment of schizophrenia in adult patients who have been adequately treated with the 1-month paliperidone palmitate injectable product for at least four months or the 3-month paliperidone palmitate injectable product following at least one 3-month injection cycle. Invega Hafyera is contraindicated in patients with a known hypersensitivity to risperidone. Invega Hafyera modified release injection contains paliperidone 700 mg/3.5 mL or 1000 mg/5 mL and is available in pack sizes of 1 pre-filled syringe.
- Sacituzumab govitecan (Trodelvy) is a Trop-2-directed antibody-drug conjugate. Sacituzumab is a humanised antibody that recognises Trop-2. The small molecule, SN-38, is a topoisomerase I inhibitor, which is covalently attached to the antibody by a linker. Sacituzumab govitecan binds to Trop-2-expressing cancer cells and is internalised with the subsequent release of SN-38 via hydrolysis of the linker. SN-38 interacts with topoisomerase I and prevents re-ligation of topoisomerase I-induced single strand breaks. The resulting DNA damage leads to apoptosis and cell death. Sacituzumab govitecan decreased tumour growth in mouse xenograft models of triple-negative breast cancer. Trodelvy is indicated for the treatment of adult patients with unresectable locally advanced or metastatic triple-negative breast cancer (mTNBC) who have received at least two prior systemic therapies, including at least one prior therapy for locally advanced or metastatic disease. Trodelvy powder for injection contains sacituzumab govitecan 180 mg and is available in a pack size of 1 single use vial.
- Trastuzumab deruxtecan (Enhertu) is a HER2-targeted antibody-drug conjugate (ADC). The antibody is a humanized anti-HER2 IgG1 attached to deruxtecan, a topoisomerase I inhibitor bound by a tetrapeptide-based cleavable linker. Following binding to HER2 on tumour cells, trastuzumab deruxtecan undergoes internalization and intracellular linker cleavage by lysosomal enzymes. Upon release, the membrane-permeable topoisomerase I inhibitor causes DNA damage and apoptotic cell death. Enhertu has provisional approval for the treatment of adult patients with unresectable or metastatic HER2-positive breast cancer who have received two or more prior anti-HER2-based regimens. Enhertu powder for injection contains trastuzumab deruxtecan 100 mg and is available in a pack size of 1 vial.
- Voretigene neparvovec (Luxturna) is a gene transfer vector designed to deliver a normal copy of the gene encoding the human retinal pigment epithelial 65 kDa protein (RPE65) to cells of the retina in persons with reduced or absent levels of biologically active RPE65. Injection of Luxturna into the subretinal space results in transduction of some retinal pigment epithelial cells with a cDNA encoding normal human RPE65 protein, thus providing the potential to restore the visual cycle. Luxturna is indicated for the treatment of patients with inherited retinal dystrophy caused by pathological biallelic RPE65 mutations and who have sufficient viable retinal cells. Luxturna is contraindicated in patients with ocular or periocular infection; and active intraocular inflammation. Luxturna concentrate for subretinal injection contains voretigene neparvovec 5 trillion vector genomes/mL and is available in a pack size of 1 foil pouch containing 1 vial (0.5 mL) of concentrate and 2 vials (each 1.7 mL) of solvent.
- Zolpidem tartrate (ZolpiMist) selectively binds the omega-1 receptor subtype (also known as the benzodiazepine-1 subtype) which is the alpha unit of the GABA-A receptor complex. The modulation of the chloride anion channel via this receptor leads to the specific sedative effects demonstrated by zolpidem i.e. the preservation of deep sleep (stage 3 and 4 slow wave sleep). ZolpiMist is indicated for the short-term treatment of insomnia in adults. ZolpiMist is contraindicated in patients with sleep apnoea; myasthenia gravis; severe hepatic insufficiency; acute and/or severe pulmonary insufficiency; prior or concomitant intake with alcohol; and who have previously experienced complex sleep behaviours after taking zolpidem. ZolpiMist should not be prescribed for children. ZolpiMist oromucosal spray contains zolpidem tartrate 5 mg/actuation and is available in a pack size of 1 oromucosal spray with 28 metered actuations.
New Indications
- Tafenoquine (as succinate) (Kozenis) is now indicated, in combination with chloroquine, for the radical cure (prevention of relapse) of Plasmodium vivax (P. vivax) malaria in adults, adolescents and children weighing greater than 35 kg.
- Ozanimod (Zeposia) is now indicated for the treatment of adult patients with moderately to severely active ulcerative colitis who have had an inadequate response, lost response, or were intolerant to either conventional therapy or a biological therapy.
New Contraindications
- Glecaprevir and pibrentasvir (Maviret) is now contraindicated in patients with moderate hepatic impairment (Child-Pugh B).
- Saxagliptin (as hydrochloride)/dapagliflozin propanediol monohydrate (Qtern 5/10) is now contraindicated in patients with history of any serious hypersensitivity reaction to any sodium glucose cotransporter 2 (SGLT2) inhibitor; and patients with eGFR persistently < 45 mL/min/1.73 m2 or patients on dialysis.
This list is a summary of only some of the changes that have occurred over the last month.
Before prescribing, always refer to the full product information.
News & Updates
New Accredited Pharmacists: May 2022
News & Updates
Congratulations to our newly accredited Pharmacists
- Shannon Hurley, NSW
- Christine Lee, NSW
- Nancy McSwiggan, NSW
- Neiti Boolaky, Qld
- Mohammad Khan, SA
- Jean Loo, Vic
- Natalie Low, Vic
- Vanthana Mayalagan, Vic
- Gisela Santa-Juliana, Vic
- Chwen Sow, WA
- Sophie Young, WA
News & Updates
Australian Prescriber Podcast Ep. 129
News & Updates
Episode 129 Home Oxygen Therapy
When and for whom should home oxygen therapy be prescribed, and what is the evidence behind it? David Liew chats with respiratory physician Christine McDonald. Read the full article in Australian Prescriber.
Click HERE to listen.
News & Updates
Australian Prescriber Podcast Ep. 130
News & Updates
Episode 130 Severe Cutaneous Adverse Drug Reactions
Some commonly prescribed medicines can cause severe damage to the skin and internal organs. Jo Cheah chats with infectious diseases physician Jason Trubiano about how to identify the drugs responsible and assess the allergy. Read the full article in Australian Prescriber.
Click HERE to listen.
News & Updates
Residential Aged Care Communiqué Podcast now available!
News & Updates
The first issue of Residential Aged Care Communiqué for 2022 focuses on falls and falls management. Every year, over half of all residents will have a fall and some have grave consequences as highlighted by the two cases. Commentaries by two of Australia’s leading international experts explain the practical interventions available to prevent falls.
https://www.thecommuniques.com/podcasts-residential-aged-care
News & Updates
News & Updates
News & Updates
Bringing more impact to a Medication Management Review – a new tool helps pharmacists
News & Updates
Research from NPS MedicineWise found that some GPs find Home Medicines Reviews are too generic, and need to be more tailored to the patient. A new tool from NPS MedicineWise supports a collaborative approach between the accredited pharmacist and medical practitioner when preparing a Home Medicines Review (HMR) or a Residential Medication Management Review (RMMR).
Medication Management Review Reports: Best practice recommendations aims to assist accredited pharmacists, or pharmacists undergoing accreditation, with applying a person-centred approach to writing MMR reports. It encourages communication between the pharmacist and referring medical practitioner to provide a common understanding of the context and goals of the report.
It also incorporates important elements that medical practitioners find most useful in a report.
NPS MedicineWise medical advisor and GP Dr Kate Annear says GPs value the important information that can be gained from seeing a person’s everyday environment in the home, and understanding their personal circumstances.
“There may be issues with how a person is using their medicines. They may have swallowing difficulties or issues reading labels or opening packaging,” says Dr Annear.
“Understanding their personal priorities and the way they use their medicines can influence recommendations from the review,” she says.
The tool was developed with valuable input and feedback from the Australian Association of Consultant Pharmacy (AACP), the Pharmacy Guild of Australia, the Pharmaceutical Society of Australia (PSA), the Australian Commission on Safety and Quality in Health Care (ACSQHC) and the Society of Hospital Pharmacists of Australia (SHPA).
Sarah Gillespie, Manager of Clinical Services at AACP says the format of the tool with recommendations makes it relevant for more people than a template.
“What works for one medical practitioner is not necessarily what works for another. A collaborative approach is necessary so that the accredited pharmacist can provide the GP with a useful and informative report that provides them with the details they are seeking to improve medicines management,” she says.
The tool was created as part of an NPS MedicineWise program to improve the safe use of medicines with anticholinergic effects for older people. Anticholinergic burden is associated with poor health outcomes including a 60% increase in fall-related hospitalisations, 50% increased risk of dementia and a 30% increased mortality. HMRs and RMMRs can help support a reduction in anticholinergic burden and associated harms for older people.
News & Updates
CPD
PSA training opportunity for accredited pharmacists in SE NSW
CPD
The PSA is seeking Expressions of Interest (EOI) from accredited pharmacists in the following regions of South-eastern NSW to undertake tailored online training to support culturally safe end of life care for Aboriginal and Torres Strait Islander members of their local community.
- Goulburn
- Queanbeyan
- Illawarra
- Nowra
- Eurobodalla (Batemans Bay, Moruya, Narooma, and surrounds)
Through this project, funded by the South-eastern NSW Primary Health Network (COORDINARE), PSA is looking to support Aboriginal and Torres Strait Islander community members to have equitable access to culturally safe and responsive palliative care support. While initially aimed at community pharmacy (pharmacists and pharmacy staff), COORDINARE would like to open up this opportunity to accredited pharmacists and hospital pharmacy staff in the key regions.
The 1.5 hour CPD-accredited workshops will be held via Zoom on:
- Tuesday 10 May from 7.00pm-8.30pm for Goulburn and Queanbeyan
- Tuesday 31 May from 7.00pm-8.30pm for Illawarra, Nowra, and Eurobodalla
To add context and to prepare for the workshop, each participant will be invited to undertake 3-4 hours of online self-directed pre-learning; pharmacists can self-record CPD for this. Further details including instructions for pre-learning will be forwarded upon completion of the EOI.
To learn more about this project and to register your interest please click HERE. If you are an accredited pharmacist not working in association with a community pharmacy or hospital pharmacy, please enter ‘accredited pharmacist’ under pharmacy name in the EOI.
For further information contact Megan.Tremlett@psa.org.au
Clinical Updates
Antidepressants and health-related quality of life (HRQoL) for patients with depression: Analysis of the medical expenditure panel survey from the United States
Clinical Updates
Despite the empirical literature demonstrating the efficacy of antidepressant medications for treatment of depression disorder, these medications’ effect on patients’ overall well-being and health-related quality of life (HRQoL) remains controversial. This study investigates the effect of antidepressant medication use on patient-reported HRQoL for patients who have depression.
Methods
A comparative cohort, secondary database analysis was conducted using data from the United States’ Medical Expenditures Panel Survey for patients who had depression. HRQoL was measured using the SF-12 and reported as physical and mental component summaries (PCS and MCS). A cohort of patients that used antidepressant medications were compared to a cohort of patients that did not. Univariate and multivariate difference-in-differences (D-I-D) analyses were used to assess the significance of the mean difference of change on the PCS and MCS from baseline to follow-up.
Results
On average, 17.5 million adults were diagnosed with depression disorder each year during the period 2005–2016. The majority were female (67.9%), a larger proportion of whom received antidepressant medications (60.5% vs. 51.5% of males). Although use of antidepressants was associated with some improvement on the MCS, D-I-D univariate analysis revealed no significant difference between the two cohorts in PCS (–0.35 vs. –0.34, p = 0.9595) or MCS (1.28 vs. 1.13, p = 0.6405). The multivariate D-I-D analyses ensured the robustness of these results.
Conclusion
The real-world effect of using antidepressant medications does not continue to improve patients’ HRQoL over time. Future studies should not only focus on the short-term effect of pharmacotherapy, it should rather investigate the long-term impact of pharmacological and non-pharmacological interventions on these patients’ HRQoL
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0265928
Clinical Updates
Association of Opioid Dose Reduction With Opioid Overdose and Opioid Use Disorder Among Patients Receiving High-Dose, Long-term Opioid Therapy in North Carolina
Clinical Updates
In this cohort study of privately insured patients receiving high-dose, long-term opioid therapy (HDLTOT) the authors found that rapid dose reduction or discontinuation, in excess of CDC guidelines, was associated with increased risk of opioid overdose and OUD over 4 years of follow-up.
Guideline-concordant gradual reduction or discontinuation had a protective association compared with maintaining or rapidly decreasing doses for the first 9 months of follow-up; however, in the longer term, maintenance of HDLTOT conferred the lowest risk of adverse outcomes compared with rapid decrease, which conferred the highest risk, and gradual decrease, which constituted an intermediate level of risk.
These findings reinforce concerns about the safety of precipitous opioid dose reductions for patients receiving HDLTOT and highlight the need for clinicians to monitor patients closely in the long term when reducing opioid doses.
Click HERE to read this paper published in JAMA Network Open.
Clinical Updates
Common conditions that mimic asthma
Clinical Updates
Asthma is one of the most common chronic diseases in Australia, affecting 11% of the population. Most patients with asthma are managed in primary care, but globally, 20–70% of patients with asthma are undiagnosed, and 30–35% of people with an asthma diagnosis do not have evidence of current asthma.
Improved access to spirometry in primary care is often proposed as the solution. However, simple spirometry is often uninformative, and some patients need several investigations to confirm the diagnosis of asthma, or to distinguish it from common mimics.
This article highlights conditions that commonly mimic asthma in adults and adolescents, with practical advice about key clinical features that can help direct initial investigations in primary care.
Click HERE to read this article from the Medical Journal of Australia
Clinical Updates
Deconditioning information for providers of services for older people and the public
Clinical Updates
The UK National Falls Prevention Co-ordination Group (NFPCG) Deconditioning task and finish sub-group have developed a suite of five resources intended to support individuals, health and care professionals and commissioners to take action to help older adults become more active and recondition following activity restrictions in the COVID-19 pandemic.
Click HERE to access the resources
Clinical Updates
Electronic cigarettes and health outcomes: systematic review of global evidence
Clinical Updates
This report aims to provide a systematic overview of the contemporary evidence on the health effects of nicotine and non-nicotine e-cigarette use, excluding where possible use of tetrahydrocannabinol (THC) and other illicit substances.
The primary health outcomes of interest include but are not limited to dependence; cardiovascular disease; cancer; respiratory disease; oral diseases; reproductive outcomes; injuries and poisonings; mental health conditions; and environmental hazards with human health implications. These findings are integrated with those from previous systematic reviews on smoking uptake and cessation.
Click HERE to access the review.
Clinical Updates
Empagliflozin Improves Quality of Life in HFpEF
Clinical Updates
Empagliflozin improved health–related quality of life among patients with heart failure with preserved ejection fraction (HFpEF), showing similar results as an earlier trial of patients with reduced ejection fraction. The analysis of the EMPEROR-Preserved trial, published in Circulation, also found that empagliflozin reduced the risk of major heart failure outcomes independent of patients’ quality of life at baseline.
The analysis included 5942 patients. Compared with placebo, patients treated with empagliflozin had significant improvement in quality of life as early as 12 weeks and sustained the benefit over 52 weeks. Regardless of patients’ baseline quality of life, empagliflozin consistently reduced time to cardiovascular death or heart failure hospitalization.
The drug’s effects on quality of life, while statistically significant, were modest. However, the authors noted, “the magnitude of the treatment effect in EMPEROR-Preserved is similar to that seen in other large-scale double-blind trials of drug therapies, particularly in patients with HFpEF….”
In February, the US Food and Drug Administration expanded its approval of empagliflozin, marketed as Jardiance, for reducing the risk of cardiovascular death and hospitalization among all adults with heart failure, including those with preserved ejection fraction.
https://jamanetwork.com/journals/jama/fullarticle/2791411?guestAccessKey=bf2f7ec2-f9e5-4ece-9cb7-629ec2646b78&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama
Clinical Updates
End of Life Directions for Aged Care (ELDAC) April Newsletter
Clinical Updates
Recognising how aged care supports end of life
The care that older Australians receive in aged care services helps older people to live as independently as possible and be cared for up to and including their end of life.
The new My Care Matters information acknowledges the care provided by aged care workers, and the difference their work makes to an older person, their family, and community.
For additional information and to access the newsletter click HERE.
Sign up to receive the monthly newsletter via email HERE.
Clinical Updates
Fourth Dose of BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting
Clinical Updates
With large waves of infection driven by the B.1.1.529 (omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), alongside evidence of waning immunity after the booster dose of coronavirus disease 2019 (Covid-19) vaccine, several countries have begun giving at-risk persons a fourth vaccine dose.
Methods
To evaluate the early effectiveness of a fourth dose of the BNT162b2 vaccine for the prevention of Covid-19–related outcomes, we analyzed data recorded by the largest health care organization in Israel from January 3 to February 18, 2022. We evaluated the relative effectiveness of a fourth vaccine dose as compared with that of a third dose given at least 4 months earlier among persons 60 years of age or older. We compared outcomes in persons who had received a fourth dose with those in persons who had not, individually matching persons from these two groups with respect to multiple sociodemographic and clinical variables. A sensitivity analysis was performed with the use of parametric Poisson regression.
Results
The primary analysis included 182,122 matched pairs. Relative vaccine effectiveness in days 7 to 30 after the fourth dose was estimated to be 45% (95% confidence interval [CI], 44 to 47) against polymerase-chain-reaction–confirmed SARS-CoV-2 infection, 55% (95% CI, 53 to 58) against symptomatic Covid-19, 68% (95% CI, 59 to 74) against Covid-19–related hospitalization, 62% (95% CI, 50 to 74) against severe Covid-19, and 74% (95% CI, 50 to 90) against Covid-19–related death. The corresponding estimates in days 14 to 30 after the fourth dose were 52% (95% CI, 49 to 54), 61% (95% CI, 58 to 64), 72% (95% CI, 63 to 79), 64% (95% CI, 48 to 77), and 76% (95% CI, 48 to 91). In days 7 to 30 after a fourth vaccine dose, the difference in the absolute risk (three doses vs. four doses) was 180.1 cases per 100,000 persons (95% CI, 142.8 to 211.9) for Covid-19–related hospitalization and 68.8 cases per 100,000 persons (95% CI, 48.5 to 91.9) for severe Covid-19. In sensitivity analyses, estimates of relative effectiveness against documented infection were similar to those in the primary analysis.
Conclusions
A fourth dose of the BNT162b2 vaccine was effective in reducing the short-term risk of Covid-19–related outcomes among persons who had received a third dose at least 4 months earlier. (Funded by the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute.)
Click HERE to read the article published in the New England Journal of Medicine.
Clinical Updates
Heart Week 2022
Clinical Updates
With one Australian having a heart attack or stroke every 4 minutes, you have the power to change this statistic.
Heart Week is Australia’s national heart health awareness week held in the first week of May each year. It provides an opportunity for health professionals and the Australian public to start a conversation about heart health and take steps to reduce their risk of heart disease.
This Heart Week (2–8 May), raise awareness about the importance of heart health.
For more information and to download a Heart Week digital promotional pack, visit the Heart Foundation website
Clinical Updates
Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults
Clinical Updates
This UK guideline covers general principles for prescribing and managing withdrawal from opioids, benzodiazepines, gabapentinoids, Z‑drugs and antidepressants in primary and secondary care.
It does not cover gabapentinoids prescribed for epilepsy, nor opioids prescribed for acute or cancer pain, or at the end of life, nor management of illicit drug dependence.
Recommendations
This guideline includes recommendations on:
Click HERE to access the guidance
Clinical Updates
Medicines Safety Update – Clozapine and gastrointestinal hypomotility with severe complications
Clinical Updates
Clozapine and gastrointestinal hypomotility with severe complications
The potentially fatal risk of gastrointestinal hypomotility in patients taking clozapine has been highlighted with a new boxed warning in the Product Information (PI) for this medicine. Health professionals should assess for constipation before and during treatment with clozapine and manage suspected constipation promptly to prevent severe complications.
Clozapine may also affect the bowels by slowing them down and can cause severe constipation. This condition is known as clozapine-induced gastrointestinal hypomotility. If untreated, it can lead to serious problems.
Consumers who take clozapine should look out for changes in their bowel function, and contact their health professional if they develop any of the following symptoms:
- no bowel movements, bowel movements less often than usual, or difficulty passing a stool
- nausea and/or vomiting
- bloating, tenderness or swelling of the abdomen
- stomach pains or spasms.
The warnings emphasise screening patients for constipation before starting and during treatment with clozapine, followed by treatment according to current clinical guidelines if necessary.
The severe gastrointestinal effects of intestinal obstruction, severe constipation and gastrointestinal hypomotility are among the most serious adverse reactions experienced with clozapine. In post-marketing experience, severe complications of gastrointestinal hypomotility (such as intestinal obstruction, faecal impaction, megacolon, paralytic ileus and intestinal ischaemia or infarction) have resulted in hospitalisation, surgery, and death.
The new boxed text and other changes to the PI expand on existing warnings about severe gastrointestinal adverse reactions associated with clozapine, which are primarily due to its potent anticholinergic effects.
For more information see the TGA website.
Clinical Updates
Parosmia—a common consequence of covid-19
Clinical Updates
Parosmia is a common sequelae of smell loss associated with covid-19, with onset on average three months after initial infection. The presence of parosmia is positively associated with better outcomes from olfactory training in patients with loss of sense of smell—they are more likely to regain their sense of smell than those without parosmia.
Click HERE to read this ‘practice pointer’ from the British Medical Journal.
Clinical Updates
Personalised prescribing: using pharmacogenomics to improve patient outcomes
Clinical Updates
The potential of personalised, precision or genomic medicine has been touted for some time. This report produced by a Royal College of Physicians and British Pharmacological Society joint working party (and the patient summary that is also available) suggests that pharmacogenomic testing, should now be deployed across the UK’s NHS to ensure all patients have an equal chance of being prescribed a medicine at a dose that is likely to be safe and effective for them, with minimal side effects
Report of a working party
Royal College of Physicians and British Pharmacological Society
London: Royal College of Physicians and British Pharmacological Society; 2022. p. 51.
https://www.rcp.ac.uk/projects/outputs/personalised-prescribing
Clinical Updates
Potential Gains in Life Expectancy Associated With Achieving Treatment Goals in US Adults With Type 2 Diabetes
Clinical Updates
This research sought to identify any potential gains in life expectancy (LE) are associated with lowering glycated haemoglobin (HbA1c), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and body mass index (BMI) toward optimal levels in people with type 2 diabetes (T2D)?
This decision analytical model using data from 421 adults with T2D showed that compared with individuals from the highest BMI, HbA1c, SBP, and LDL-C population quartile, those from the lowest BMI, HbA1c, SBP, and LDL-C population quartile had 3.9, 3.8, 1.9, and 0.9 years of additional LE, respectively.
These findings suggest that achieving recommended goals is likely to extend the LE of people with T2D.
Click HERE to read the study from JAMA Network Open.
Clinical Updates
Practical recommendations to communicate with patients about health‐related conspiracy theories
Clinical Updates
Addressing patients’ beliefs in health conspiracy theories requires an understanding of underlying motivations
Research has shown that people who endorsed COVID‐19 conspiracy theories (e.g., that the virus was a hoax) were more likely to believe that hydroxychloroquine was an effective treatment. Also, beliefs in popular pro‐hydroxychloroquine conspiracy theories (e.g., the pharmaceutical industry, in collusion with the government, was preventing the distribution of chloroquine treatments in order to protect its financial interests) were more positive towards hydroxychloroquine treatment, less positive towards COVID‐19 vaccinations, and less likely to get a COVID‐19 vaccine.
These recent findings illustrate how health‐related conspiracy theories can have real impacts on both attitudes towards medical research and health decisions. This article explains what health‐related conspiracy theories and their consequences are and why some patients might hold these beliefs and will offer some practical recommendations about how to engage with patients who believe in these theories.
Click HERE to read this article from the Medical Journal of Australia.
Clinical Updates
Clinical Updates
The Weakness of Will: The Role of Free Will in Treatment Adherence
Clinical Updates
Chronic disease prevention and management requires a lifelong commitment and adherence to lifestyle modifications, monitoring of symptoms, medication use, and other forms of therapy. Treatment adherence is a crucial and complex concept in patient care provision, and it requires the voluntary active involvement of patients for the best possible outcome. Multiple factors, which may or may not be under the patient’s control, can influence treatment adherence.
However, adherence or non-adherence to a certain treatment is predominantly influenced by one’s sense of agency, values, beliefs, attitudes, and willpower. It is evident that mental states appear to influence patients’ decision-making, and the best treatment outcome occurs when a patient identifies their goals, needs, and desires and exercises their decision-making and free will during the course of receiving care. The role of healthcare providers is critical in promoting treatment adherence, thereby enhancing patient outcomes.
Thus, this paper highlights the importance of promoting a sense of agency and integrating patients’ values, beliefs, attitudes, and intentions during the provision of healthcare. It is indispensable to recognize the individual’s ability and initiative to control and manage their illness in the face of challenging socioeconomic and cultural reality. On logical grounds, it is not enough to appreciate the value of free will and mental states, it is also essential to empower and cultivate an individual patient’s willpower to make a well-informed, free decision based on their mental state for the most optimal treatment outcomes.
https://www.dovepress.com/articles.php?article_id=74941
Clinical Updates
Treatable traits in asthma: moving beyond diagnostic labels
Clinical Updates
A precision medicine approach to asthma places the patient at the centre of their care
Asthma is a common inflammatory disease, affecting over 300 million people worldwide, including one in nine Australian adults. Asthma imposes a major burden on the health care system, on patients, and within society. In the late 20th century and the early 2000s, there were major improvements in asthma outcomes, largely because of the introduction of inhaled corticosteroids to treat eosinophilic airway inflammation, and asthma self‐management education initiatives. These improvements in asthma outcomes are now being lost. Hospitalisations and mortality from asthma have begun to rise as adoption of new assessment techniques and biomarkers into practice stagnates, and we experience sluggish development of new drug discovery in comparison to other diseases. Asthma deaths have risen in Australia, the United Kingdom and the United States, with at least one person in Australia dying every day from asthma.
The need to improve outcomes for people with asthma is therefore great. Despite advances in treatment, people continue to die, they experience an ongoing burden from acute attacks and symptoms, and those with severe disease suffer severe iatrogenic consequences of treatment, in particular from oral corticosteroids. This results in major deleterious impacts on patients’ relationships, their ability to live the life they desire, and workplace absenteeism and loss of productivity.
These issues mandate a new approach to asthma management, and indeed airway disease. The authors propose that this be addressed using a precision medicine approach. Precision medicine is delivering real and significant outcomes in many areas, including cancer and other respiratory diseases, and it is now time to progress precision medicine in asthma.
Treatable Traits is a precision medicine approach that has been developed and proposed for the management of obstructive airway diseases, including asthma. It is achieving global support in the international guidelines for chronic obstructive pulmonary disease (COPD) and severe asthma, as well as being the subject of major symposia at national and international respiratory meetings. A PubMed search (16 December 2020) using the term “treatable traits” identified 192 publications since 2016, the date of the first publication proposing the term for the approach.
Click HERE to read more of this article from the Medical Journal of Australia
Clinical Updates
Treatment of Menopause Symptoms With Hormone Therapy
Clinical Updates
Click HERE to read this JAMA patient page
Clinical Updates
Whom to Treat for Primary Prevention of Atherosclerotic Cardiovascular Disease
Clinical Updates
The Aspirin Dilemma
The US Preventive Services Task Force (USPSTF) has released its updated 2022 recommendations, supported by an updated evidence report, to guide the use of low-dose aspirin for the primary prevention of atherosclerotic cardiovascular disease (ASCVD), changing the age ranges and recommendation grades and focusing on preventing ASCVD events.
It now gives a C recommendation (recommend individualizing the decision to initiate low-dose aspirin) for adults aged 40 to 59 years with a 10-year ASCVD risk 10% or greater and not at increased bleeding risk, and a D recommendation (recommend against initiating) for those 60 years and older (see Table).
For colorectal cancer, the 2022 recommendations concluded that the data were insufficient. This contrasts with the 2016 USPSTF recommendations, which addressed both ASCVD and colorectal cancer prevention and gave a B recommendation (recommend initiating) for adults aged 50 to 59 years with a 10-year ASCVD risk 10% or greater with a life expectancy of at least 10 years and not at increased bleeding risk, a C recommendation (recommend individualizing the decision to initiate low-dose aspirin) for select adults aged 60 to 69 years with a 10-year ASCVD risk 10% or greater, and I recommendation (insufficient evidence) for adults 70 years and older or younger than 50 years.
Click HERE to access a series of articles including a page specifically designed for patients.
Clinical Updates
Emerging evidence for the use of colchicine for secondary prevention of coronary heart disease
Clinical Updates
Colchicine is an inexpensive new treatment for coronary heart disease that is both safe and effective in select patients
Cardiovascular disease imposes a major burden on Australians and the Australian health care system. Due to campaigns to reduce smoking and the widespread use of effective lipid‐lowering therapy, there has been a significant decline in the death rate from cardiovascular disease over several decades. However, nearly 600 000 patients are hospitalised each year with cardiovascular disease, at a cost to the community of over $4 billion in 2018–19. Patients with coronary heart disease face an ongoing risk of cardiovascular events even when their lipid‐lowering and antithrombotic therapy is optimal.
Thus, to reduce morbidity in these patients, there is a need for doctors to employ additional therapies that are effective, safe, readily available, and cost‐efficient for this purpose. In the past decade, increasing evidence has accrued suggesting that there are cardiovascular benefits associated with adding colchicine 0.5 mg daily to lipid‐lowering and antithrombotic therapy for secondary prevention of coronary heart disease.
Click HERE to read this article from the Medical Journal of Australia.
