National President’s Message: COVID-19 Update

3 June 2020

 

The COVID-19 pandemic has passed 6 million reported cases globally, and the global death toll is nearing 400,000 people. As other comparable countries have struggled to get the pandemic under control their health systems have been overwhelmed. In contrast, our health system and its health professionals pivoted to quickly create capacity which thankfully has not been needed.

 

Australia can credit its extraordinary success in supressing COVID-19 to date to several factors: decisive and collaborative leadership; respect for medical evidence and population health expertise, health systems designed to protect public health, and the natural advantage of being an island nation. Perhaps most significantly, Australia success comes from a community of over 25 million people who have collectively recognised, respected and adhered to extraordinary tough stay-at-home public health orders.

 

Our success hasn’t however been without its problems. The issues faced by many of you including panic buying, inadequate infection control support, legislative disparities between governments, communication of regulatory changes and the abuse and threats that you were subjected to informed PSA’s submission to the COVID-19 Senate Inquiry. These problems are opportunities to better prepare for future health emergencies, which PSA detailed in 17 recommendations within our submission which was lodged last week.

 

As society adjusts to a post-lockdown COVID-normal, some potentially long-term benefits are emerging. The embedding of telehealth and electronic prescribing as mainstream features of our health system will have long term benefits for the health of Australians and the health professionals who serve them. There is hope last Friday’s announcement to replace COAG with the National Cabinet will usher in an era of reform, reduced red-tape and focus on outcomes rather than process, particularly in our health systems.

 

I encourage you to reflect on what silver-linings you want to embed permanently to take into your COVID-normal and post-COVID practice.

 

Supporting you with electronic prescriptions: starting now

 

The Australian Digital Health Agency has published further details of how electronic prescription communities of interest will be established through June this year to support the phased implementation.

 

Communities of interest are effectively an area where real-life testing is undertaken on a system. For electronic prescriptions, communities of interest will help demonstrate how well prescription delivery services, prescribe, dispense, and third-party intermediary applications integrate and work together. Anglesea, where the first primary care electronic prescription was prescribed and dispensed in May, is the first community of interest with more being established during June.

 

While initially, the electronic prescribing communities of interest will only test the token model, the Active Script List Model will begin to be tested in communities of interest from August 2020.

 

If you know a prescriber who is keen to get on board with electronic prescriptions, I encourage those of you who are pharmacy owners or managers to reach out to your software vendors to help you get ready and possibly be part of a community of interest.

 

Last week’s webinar saw very high interest with so many of you having questions regarding electronic scripts and how they will be implemented. Unfortunately, due to the sheer volume of questions we weren’t able to get through everyone’s queries in the allocated time, but there are lots of options over the next few weeks to help you get the information you need.

 

PSA’s new electronic prescribing support line is staffed by experienced pharmacists who have access to the latest workflow information on how to adopt electronic prescriptions. I encourage you to contact them with your questions via 1300 955 162 (8:30am to 5:00pm AEST, Monday to Friday) or email ep@psa.org.au.

 

There will also be further webinars hosted by PSA and the Agency, as well as our dedicated electronic prescribing webpage: www-dev/ep.

 

Looking for some career innovation and inspiration?

 

Tonight, Lauren Burton, PSA’s early career pharmacist board director, will chat with 10 pharmacists who have each taken very different paths through the profession. Lauren will help draw out what a ‘normal’ day in their practice looks like, what drives them in their professional role, and how they forged their path.

 

I strongly encourage all members, particularly early career pharmacists and those at a career cross-roads to join, what should be, a magnificent showcase of the profession tonight.

 

You can register for the live session here.

 

Opioid changes

 

Yesterday’s PBS June updates saw revision to listing of many opioid medicines, including paracetamol/codeine and tramadol listings. These changes include introduction of streamlined authorities, reduced quantities and reduced repeats.

 

As with all PBS changes, there are a few bumps in the transition period as it can take time for prescribers to become aware of the change – particularly if prescribing software is not updated on the first day of the month. I encourage you to reach out to prescribers to help communicate this change.

 

The PBS changes represent an opportunity to talk with patients and prescribers about potentially inappropriate prescribing of opioid medicines – particularly where large quantities or a large number of repeats are prescribed for either PBS or non-PBS supply.

 

Opioids are major contributor to medicine harm in Australia. These PBS changes are one of a series of initiatives being rolled out in coming months to improve medicine safety in the prescribing, supply and use of opioids – such as reduced pack sizes, real-time prescription monitoring and updated guidelines. PSA continues to work collaboratively with government agencies and key medicine stakeholders to lead and embed these important changes which are so important in reducing the harms caused by opioid medicines in the Australian community.

 

Bushfire recovery: supporting resilience

 

As the Royal Commission into National Natural Disaster Arrangements (more commonly known as the ‘Bushfire Royal Commission’) hearings are underway, there has been a renewed political focus on helping affected Australians recover from the trauma of summer. I wrote a few weeks ago about mental health first aid training available to pharmacists in bushfire affection regions of Australia. The training, supported by the federal government, ran online over a number of video sessions.

 

I’m pleased to report these workshops were completely booked out with extremely positive feedback from those of you who participated. I was particularly taken with some of your feedback, including the following reflective post:

“I found myself constantly thinking back to past HMRs where these skills would have been super handy or perhaps I tried to apply these skills unknowingly, but now I have a framework to help me nut out the issues.”

 

I’m proud PSA has been involved in such important work which will help those of you in affected areas support recovery and build resilience in your communities.

 

Stay up to date

 

Stay tuned to our social media channels and dedicated COVID-19 microsite to stay up to date with the information you need.

 

Sincerely,

Associate Professor Chris Freeman

National President

Pharmaceutical Society of Australia

National President’s Message: COVID-19 Update

26 May 2020

 

As the pandemic grows by more than 100,000 new cases globally each day and the epicentre shifts to South America, in Australia, it feels like the worst is behind us with only 5-10 new cases reported nationally each day.

 

In the past week, Premiers and Chief Ministers around the country have announced and implemented a modest winding back of restrictions, which have included guidance on modifications needed to reopen business and the community in a modified ‘COVID-normal’ way. In doing so, they have emphasised these restrictions are likely to be our new normal for a long, long time – likely to be normal until a vaccine is developed.

 

There are positive signals on the vaccine development front with a US biotechnology company beginning human trials in Australia (Melbourne and Brisbane) of a coronavirus vaccine. The trial will focus on the safety aspects of the vaccine and will also look for early signs of effectiveness. There is now about a dozen experimental vaccines which are in early stages of testing or on the eve of commencing, mostly in the US, Europe, and China.

 

As the rest of Australia transitions from lockdown to COVID-normal, actively consider; what does your COVID-normal looks like? What semi-permanent changes do you need to make to your practice? How will you maintain increased infection control, physical distancing for staff/patients and supporting unwell people stay-at-home (staff and customers) until a vaccine is developed? What temporary signage and process workarounds need to become embedded as being more permanent?

 

Supporting you with electronic prescriptions: starting now

 

Temporary digital image prescriptions during COVID-19 have been critical to ensure the supply of medicines during the global pandemic – but it has put significant pressure on you with regulatory confusion and in some instances has put pharmacists in regulatory peril.

 

I welcome the imminent implementation of electronic prescribing in a staged and planned approach – which will see a safer, clearer and more secure prescribing model, supporting pharmacists and protect patient’s privacy and safety.

 

I am confident that the work PSA has done with the Australian Digital Health Agency will result in the reduction of many of the bugbears and regulatory issues of digital image prescribing and paper prescriptions.

 

As electronic prescriptions go live, it’s important you what to do when the first patient presents an electronic prescription to you in your practice.

 

To support you, PSA, in partnership with the Agency now offers a dedicated electronic prescribing support line for pharmacists. The support line is staffed by experienced pharmacists who have access to the latest workflow information on how to adopt electronic prescriptions.

 

You can contact the support line on 1300 955 162 (8:30am to 7:00pm AEST, Monday to Friday) or email ep@psa.org.au.

 

PSA has also created a dedicated electronic prescribing webpage which contains all the latest up to date information and resources for pharmacists: www-dev/ep.

 

Webinar: Electronic prescriptions

 

This Wednesday night, the agency’s Andrew Matthews MPS, Director of Medicine Safety Programs, and Kate Ellis Manager, Provider Adoption will join me to discuss everything you need to know about electronic prescriptions and answer your questions.

 

7.30pm (EST) Wednesday 27 May

Register here.

 

PBS opioid changes from 1 June

 

The Australian Government, through the Department of Health, is implementing a range of changes to minimise the harms to Australians caused by opioid medicines. One of these measures is PBS changes which affect prescriptions written from 1 June.

 

These PBS changes include amendments to existing restriction requirements and arrangements for increased quantities and repeats. In addition, there are new Restricted Benefit listings for smaller maximum quantities of immediate release opioids, with no increased quantities or repeats, for patients requiring short-term relief of acute severe pain.

 

The 1 June PBS changes affect most opioid Controlled Drugs, as well as tramadol and paracetamol+codeine combination products.

 

I encourage you to start socialising these changes with your patients and medical colleagues to help transition as smoothly as possible to these new arrangements.

 

Supporting Australians to put their health first

 

On behalf of PSA, I am pleased to join with other peak bodies and consumer support groups in calling Australians to take action to avoid a second wave of health problems from reduced screening, management and monitoring of serious health conditions.

 

This call, in an open letter to Australians, encourages people to get the health care they need, whether that be screening, getting treatments from an allied health provider or having a telehealth consultation with their pharmacist.

 

Now is the time to reach out to patients who have disengaged from managing their chronic health conditions, particularly those who you may not have seen for a while. This can include undertaking medicine reviews, calling patients you haven’t seen for a while, discussing adherence during repeat dispensing or providing recommendations for screening services when non-prescription medicine requests warrant.

 

Provisions for medicine review services (e.g. Medschecks, HMRs) to be conducted via telehealth are available and I encourage you to promote them to your patients where they provide an avenue for people trying to avoid public contact to get the expert pharmacist care they need.

 

Medicine limits and restrictions remain

 

I am pleased to hear many of the medicine shortages which arose in March and April from increased patient demand for prescription and non-prescription medicines – in particularly salbutamol, paediatric analgesics, hydroxychloroquine – are well on their way to returning to more stable levels.

 

Back in March, PSA, together with the Government, the Pharmacy Guild of Australia and the National Pharmaceutical Services Association agreed to dispensing and supply limits for nominated medicines. Your hard work, the work of all pharmacists and the work of suppliers has been absolutely essential to restoring stability in the supply chain; helping medicines be available for everyone.

 

Limitations to the Schedule 3 listing of salbutamol are a permanent regulatory change; meaning the single inhaler limit and requirement for the patient to provide evidence of medical diagnosis of a respiratory condition or dispensing history at the supplying pharmacy remain.

 

As we move to a COVID-normal environment, it is essential adherence to these limits continue to maintain ongoing stability of the supply change. As many of you are aware, a large number of medicines remain out-of-stock or on constrained supply. Continuing to play our part helps ensure essential medicines will be available to as many Australians as possible when they need them. Something more important than ever as we focus on consumers with management of their chronic health conditions.

 

The non-COVID19 curves likely to rebound

 

Social distancing hasn’t just flattened and squashed the COVID-19 curve, it has also limited the transmission of other infectious diseases. Confirmed cases of other notifiable infectious diseases such as influenza, chlamydia and norovirus have been significantly lower in recent months. While some of this may be attributed to people not seeking usual medical care and pathology testing, limited social interaction and increased infection control measures has seen dramatic drops in community prevalence of these conditions.

 

The graduated return to workplaces, schools and social gatherings in a COVID-normal community will likely see increased rates of non-COVID infectious diseases, with health authorities renewing calls for influenza vaccination this week.

 

When responding to queries about respiratory conditions, the messages we have become accustomed to during COVID-19 remain the same: Stay at home if sick. Get tested if you have unexplained fever or any respiratory symptoms. Maintain physical distancing. Limit social interaction if vulnerable. Download the COVIDSafe App.

 

Your voice to parliament: highlighting the lessons of COVID-19

 

This week PSA will be submitting its response to the Senate Inquiry into the health response to COVID-19, which will highlight the challenges faced with medicines shortages, digital image prescribing and regulatory confusion. It will outline important lessons learnt as well as examine the extraordinary strength and purpose pharmacists demonstrated in supporting Australians under unparalleled pressure and community panic.

 

In the submission we will be highlighting the challenges faced with medicine shortages, digital image prescribing, regulatory confusion between the Commonwealth and state jurisdictions and the challenges with the TGA’s Serious Shortage Medicine Substitution Notices.

 

I will share the submission with you once it has been published on the Senate’s website.

 

Providing further clarity on emergency supply options

 

How well do you know your state/territory legal requirements for phoned/faxed prescriptions?

 

What conditions need to be met to use the emergency supply ‘3-day rule’ if someone doesn’t meet the requirements for Expanded Continued Dispensing (or one month emergency non-PBS supply during where allowed)?

 

The application of these requirements has been a point of tension with prescribers during COVID-19 where they need to be followed when prescriptions aren’t eligible to be supplied under temporary COVID-19 provisions (digital image prescriptions and Expanded Continued Dispensing).

 

Our dedicated COVID-19 microsite has been updated with state-specific mapping these requirements to help clarify requirements for prescriptions unable to be supplied as digital image prescriptions or under Expanded Continued Dispensing arrangements.

 

The microsite also continues to be updated daily with information relevant to your practice.

 

Sincerely,

Associate Professor Chris Freeman

National President

Pharmaceutical Society of Australia