The National Prescribing Service (NPS)is a valued independent resource for good and unbiased prescribing information and education.
Given the marketing pressures applied by global drug companies, Australia is blessed to have such a resource.
Pharmacists are moving closer to a prescribing role within the health system and it is appropriate that i2P promote the message of the NPS.
* Information about prescribing antidepressants in children
* NPS reaches out to remote pharmacists
* Generic medicines messages target Chinese and Italian communities
* New NPS patient resource on infective endocarditis
* Side effects warning about varenicline (Champix)
* NPS RADAR helps prescribers navigate decision-making
* Generic medicines ancillary label here to stay
Information about prescribing antidepressants in children
In response to reports of high rates of prescribing of selective serotonin re-uptake inhibitors (SSRIs) for infants and youths, the National Prescribing Service (NPS) has drawn together existing information resources and made them available in one convenient place on the NPS website to assist health professionals.
“NPS is working with the Department of Health and Ageing and Medicare Australia to further clarify the nature of current prescribing practice in this area,” NPS CEO, Dr Lynn Weekes said.
“In the meantime, health professionals seeking evidence-based information about management of depression in children can go to www.nps.org.au. The web page includes previously published NPS documents including NPS RADAR and Australian Prescriber articles, beyondblue resources and RACGP guidelines on best practice in this area.”
Another source of information is the Therapeutic Advice and Information Service (TAIS), which is a free medicines information telephone line specifically for health professionals including doctors, pharmacists and nurses.
TAIS is funded by NPS and is staffed by specialist drug information pharmacists, who can provide up-to-date information in response to health professionals’ specific questions about medicines.
“During 2007-08, 15.6 per cent of the 5865 calls to TAIS related to nervous system (psychiatric) medicines, second only to questions about antibiotics. So clearly there is a need for more easily accessible information about these medicines. This webpage goes some way in addressing the problem, and will be up-dated as new resources are developed,” Dr Weekes said.
A link to the new web page is located under ‘Health Professionals – quick links’ at www.nps.org.au.
Enquiries to Katie Butt, Media Adviser, 0419 618 365 or email firstname.lastname@example.org.
NPS reaches out to remote pharmacists
Pharmacists who are involved in providing pharmacy services to remote Aboriginal Health Services are invited to participate in a National Prescribing Service Limited (NPS) program that enhances Quality Use of Medicines in these communities.
NPS first launched the NPS Outreach Pharmacists for Remote Aboriginal Health Service program, which supports pharmacists working with remote Aboriginal communities, in June 2008. This program was initially piloted in the Northern Territory but will now extend to pharmacists across Australia, with workshops scheduled to begin in March 2009.
Participation in the program assists pharmacists to meet the QUM and educational requirements of the contractual agreements with the Aboriginal Health Services.
Involvement in this program consists of:
· Structured training workshops twice yearly consisting of clinical information updates and communication skills development
· Resources to assist pharmacists to meet the educational needs of the staff and clients at the Aboriginal Health Services
· Ongoing support to assist pharmacists in implementing the program in the Aboriginal Health Services, and facilitate inter-professional communication
· Educational sessions to the staff at the Aboriginal Health Services on two therapeutic topics annually
· Participating in teleconferences periodically to feedback on the implementation process
· Provision of a short activity report at the conclusion of each therapeutic topic outlining the reach of the program within the Aboriginal Health Services. The reporting is a component of that required by the Department of Health and Ageing under the s100 support allowance, minimising any additional burden to participants.
“Working with remote communities is often very demanding and isolating. By participating in this program pharmacists will be able to expand their knowledge through continuing education and have an opportunity to network with other pharmacists who work with aboriginal communities, while health services will benefit from the pharmacists’ improved skills,” NPS Education and Quality Assurance Program Manager, Judith Mackson said.
The workshops are free and NPS will cover the costs of participating in the program such as travel to training workshops, background reading materials, workshop materials, teleconference support and other useful resources.
Pharmacists interested in participating in the NPS Outreach Pharmacists for Remote Aboriginal Health Service program, contact Pippa Travers-Mason on (02) 8217 8700 or email@example.com.
Generic medicines messages target Chinese and Italian communities
The third phase of the National Prescribing Service Limited’s (NPS) Generic medicines are an equal choice campaign will begin on 1 February with targeted messages to seniors in culturally and linguistically diverse communities.
Community service announcements and interviews with health professionals will be broadcast in Cantonese, Mandarin and Italian on SBS and other community-language radio stations across Australia, while printed in-language resources are being developed in partnership with the Federation of Ethnic Communities’ Councils of Australia (FECCA) and will be available in mid March.
“NPS and FECCA have undertaken research which highlights the need for more accessible information around generic medicines for Italian and Chinese seniors. This campaign is an important means of enhancing awareness and dispelling misconceptions about generic medicines and ensuring diverse Australians have the knowledge and skills to make informed decisions about their health”, FECCA Director, Peter van Vliet, said.
“Receiving accurate and reliable information about medicines is essential to achieving positive health outcomes. Yet for culturally and linguistically diverse seniors, such information may be difficult to access due to language barriers, low levels of cultural competency of health systems, or the experience of navigating unfamiliar medicines systems”, Mr van Vliet said.
The key message during this phase of the campaign is that generic medicines contain the same active ingredient as the original brand medicines, although they may look different or come in different packaging. Reiterating that generic medicines meet the same Australian government standards as other medicines is also very important.
Seniors from culturally and linguistically diverse backgrounds are encouraged to speak to their doctor or pharmacist to discuss whether there may be a generic medicine suitable for them.
“We know that seniors from communities who speak languages other than English are particularly inclined to listen and consider medicines information from their doctors and pharmacists. The role health professionals play in explaining and reinforcing messages about understanding medicine and using medicines safely is extremely important,” NPS Deputy CEO, Karen Kaye said.
Health professionals should also be aware that there may be difficulties with the direct translation of ‘generic’ for some languages. For example, direct Italian translation of ‘generic medicine’ could be understood as being any medicine that is not a ‘Prescription Only’ medicine.
“Language barriers should not prevent people from understanding and having access to information about medicines,” Ms Kaye said.
Pharmacies needing translation services can call the Department of Immigration and Citizenship’s free Translation and Interpreting Service on 131 450.
New NPS patient resource on infective endocarditis
Health professionals can now access a new information leaflet explaining recent changes to infective endocarditis guidelines, which has been developed by the National Prescribing Service Ltd (NPS) for consumers.
In July 2008, Therapeutic Guidelines published revised guidelines for the use of antibiotic prophylaxis for preventing infective endocarditis. The new guidelines:
· recommend antibiotic prophylaxis only for patients with the highest risk of adverse outcomes
· specify the procedures for which antibiotic prophylaxis is now recommended.
The patient information leaflet explains the recent changes to antibiotic prophylaxis guidelines in lay terms and discusses the heart conditions and procedures that warrant prophylaxis.
“This online resource will help dentists, doctors and other health professionals to explain the changes to patients, especially those who may be anxious about how the changes will affect them,” NPS Executive Manager of Quality Use of Medicines Programs, Karen Kaye, said.
The Australian Dental Association, Therapeutic Guidelines and the Cardiac Society of Australia and New Zealand have endorsed the patient information leaflet.
Health professionals can download the patient leaflet free of charge from the NPS website:
Side effects warning about varenicline (Champix)
The National Prescribing Service Limited (NPS) advises people taking the quit-smoking drug varenicline (marketed in Australia as Champix) to speak to their GP or pharmacist or contact Medicines Line if they are concerned about possible side effects.
In its December newsletter, the Adverse Drugs Reactions Advisory Committee (ADRAC) said it had received a number of adverse reaction reports for varenicline which included depression, aggression, agitation, abnormal dreams, insomnia, hallucination and anger as well as reports of suicidal/self-injurious ideation or behaviour.
“As is often the case with any new medicine, it is only once it has been on the market for awhile and more people use it that unknown side effects come to light,” NPS CEO, Lynn Weekes said.
“Varenicline is still a useful medicine for those who have been unsuccessful with other smoking cessation products and methods. While these side effects are serious and should be taken into consideration before starting this medicine, the number of reported adverse events indicates only a small percentage of patients have been affected.”
“If you think you have experienced a side effect speak to your GP or pharmacist, or call Medicines Line on 1300 888 763, which is an information service operated by a pharmacist for people who have queries about their medicines.”
“If you are caring for someone who is taking varenicline keep an eye on their behaviour, especially if they have a history of psychiatric illness.”
Prescribers are reminded to discuss possible side effects of varenicline with patients and exercise caution when prescribing it to patients with a history of seizure disorder.
A number of resources on varenicline are available for consumers and healthcare professionals through the NPS website including the consumer medicine information (CMI) sheet, peer reviews and journal articles.
“When starting any new medicine people should read the Consumer Medicine Information (CMI) sheet which explains how the medicine works, what it’s for, how best to take it and any potential side effects,” Dr Weekes said.
Articles have been published in NPS’ Medicines Update, which is written for consumers and discusses medicines when they are added to the Pharmaceutical Benefits Scheme (PBS), and RADAR, which also discusses recently listed PBS medicines but is written for healthcare professionals.
NPS RADAR helps prescribers navigate decision-making
Prescribers considering use of zoledronic acid (Aclasta) once-yearly infusion in patients who have osteoporosis will need to weigh up the possible benefits against the relative lack of experience with this drug in osteoporosis.
This month’s NPS RADAR review of the newly PBS-listed drug provides information to help prescribers’ decision-making and to counsel patients.
“Zoledronic acid is an alternative to oral bisphosphonates and may be particularly useful for those patients who cannot tolerate or who have difficulty taking oral bisphosphonates, however, the dosing convenience of an annual infusion will be somewhat limited if patients need calcium and vitamin D supplements as these will still need to be taken daily,” NPS Deputy CEO, Karen Kaye, said.
“Prescribers need to balance the possible risks and benefits of any new drug,” Ms Kaye said.
“Like other bisphosphonates, zoledronic acid has been associated with serious, often delayed, adverse effects, including renal dysfunction, inflammatory ocular disorders, osteonecrosis of the jaw and possibly atrial fibrillation.
“Most safety data for zoledronic acid are from its use at higher doses for malignancy, so there’s relatively limited experience with its use in osteoporosis. We don’t yet know if the risk of osteonecrosis of the jaw differs from that with oral bisphosphonates in people treated for osteoporosis,” Ms Kaye said.
Acute-phase reactions, such as fever, myalgia, flu-like illness and headache, frequently occur within three days of infusion.
Before prescribing zoledronic acid, GPs should check if patients have received their first infusion in hospital and should ensure that oral bisphosphonates are stopped.
The importance of patient counselling, particularly to avoid confusion between formulations, is also highlighted in reviews of new once-daily formulations of tramadol (Durotram XR) and quetiapine (Seroquel XR).
“With a number of tramadol formulations now available, with different dosing frequencies and brand names, it’s particularly important to provide clear information to patients to avoid confusion and possible errors,” Ms Kaye said.
“Ensure that patients are aware that tramadol extended-release is a once-daily tablet and advise them not to take any other product containing tramadol while using tramadol extended-release, without speaking to a doctor or pharmacist,” Ms Kaye said.
The quetiapine extended-release tablets come in different strengths from those of the existing immediate-release tablets, and dosing and administration is slightly different.
“There is no compelling reason to switch people who are currently stable on quetiapine immediate-release tablets to extended-release tablets. Prescribers will need to instruct patients carefully to prevent confusion between the two formulations,” Ms Kaye said.
Consumer reviews of both zoledronic acid and tramadol are available at www.nps.org.au in the latest editions of Medicine Update. These may assist when counselling patients.
Generic medicines ancillary label here to stay
The new ancillary label designed as part of the Generic medicines are an equal choice campaign is to be included as an alternate label 15 in the 21st edition of the Australian Pharmaceutical Formulary and Handbook.
The label was designed in consultation with the PSA, the Pharmacy Guild of Australia, practicing community pharmacists and consumers as part of the 2008 NPS Generic Medicines are an Equal Choice campaign. The APF Editorial Board has agreed to include it in the 21st edition of the APF handbook, which is due out in early 2009.
”The label will provide a reminder for consumers to know the active ingredient name of the medicines they take and will provide a trigger to seek advice from their pharmacist. The APF is pleased to include this additional label as a tool to support effective communication with consumers regarding the quality use of medicines,” Lloyd Sansom Chair Editorial Board of the APF-21, said.
To increase readability and understanding for consumers the new label includes an area to write the name of the active ingredient of the medicine and is larger than the existing 15b label. It also gives pharmacists another tool to use when having discussions about generic medicines and active ingredient names with their patients.
“The label supports best practice in community pharmacies when discussing generic medicines with consumers. We encourage pharmacists and their staff to point out the active ingredient name on the label and/or medicine packaging when talking to consumers,” NPS CEO, Dr Lynn Weekes said.
“By knowing the active ingredient, consumers can be confident that they are receiving the correct medicine and ensure they aren’t doubling up on their medicines should they switch brands.”
Best practice includes only offering a generic brand at the prescription intake point when it is safe and appropriate to do so. Brand substitution should only occur if the ‘no substitution’ box on the script remains unchecked and the patient has given their consent.
Pharmacists are also reminded they can train staff on generic medicines using the PSA Pharmacy Self Care storyboard or materials from the NPS website.
To order more prescription intake forms, ancillary labels or repeat folders (which can be overprinted with your pharmacy details) from the pharmacy tool kit phone Stirling Fildes on 1300 651 118.
Should you have any feedback regarding any of the products in the pharmacy took kit, please send your comments to info@nps