An expanded prescribing role for pharmacists – an Australian perspective

Expanded pharmacist prescribing is a new professional practice area for pharmacists. Currently, Australian pharmacists' prescribing role is limited to over-the-counter medications. This review aims to identify Australian studies involving the area of expanded pharmacist prescribing. Australian studies exploring the issues of pharmacist prescribing were identified and considered in the context of its implementation internationally. Australian studies have mainly focused on the attitudes of community and hospital pharmacists towards such an expansion. Studies evaluating the views of Australian consumers and pharmacy clients were also considered. The available Australian literature indicated support from pharmacists and pharmacy clients for an expanded pharmacist prescribing role, with preference for doctors retaining a primary role in diagnosis. Australian pharmacists and pharmacy client's views were also in agreement in terms of other key issues surrounding expanded pharmacist prescribing. These included the nature of an expanded prescribing model, the need for additional training for pharmacists and the potential for pharmacy clients gaining improved medication access, which could be achieved within an expanded role that pharmacists could provide. Current evidence from studies conducted in Australia provides valuable insight to relevant policymakers on the issue of pharmacist prescribing in order to move the agenda of pharmacist prescribing forwards

Stability studies of lincomycin hydrochloride in aqueous solution and intravenous infusion fluids

Purpose: The purpose of this study was to evaluate the chemical stability of Lincocin® (lincomycin hydrochloride) in commonly used intravenous fluids at room temperature (25°C), at accelerated-degradation temperatures and in selected buffer solutions. Materials and methods: The stability of Lincocin® injection (containing lincomycin 600 mg/2 mL as the hydrochloride) stored at 25°C±0.1°C in sodium lactate (Hartmann’s), 0.9% sodium chloride, 5% glucose, and 10% glucose solutions was investigated over 31 days. Forced degradation of Lincocin® in hydrochloric acid, sodium hydroxide, and hydrogen peroxide was performed at 60°C. The effect of pH on the degradation rate of lincomycin hydrochloride stored at 80°C was determined. Results: Lincomycin hydrochloride was found to maintain its shelf life at 25°C in sodium lactate (Hartmann’s) solution, 0.9% sodium chloride solution, 5% glucose solution, and 10% glucose solution, with less than 5% lincomycin degradation occurring in all intravenous solutions over a 31-day period. Lincomycin hydrochloride showed less rapid degradation at 60°C in acid than in basic solution, but degraded rapidly in hydrogen peroxide. At all pH values tested, lincomycin followed first-order kinetics. It had the greatest stability near pH 4 when stored at 80°C (calculated shelf life of 4.59 days), and was least stable at pH 2 (calculated shelf life of 0.38 days). Conclusion: Lincocin® injection was chemically found to have a shelf life of at least 31 days at 25°C when added to sodium lactate (Hartmann’s) solution, 0.9% sodium chloride solution, 5% glucose solution, and 10% glucose solution. Solutions prepared at approximately pH 4 are likely to have optimum stability

A comparative evaluation of pharmacy services in single and no pharmacy towns

BACKGROUND: Recent attention has focused on access of communities to pharmacy services in rural areas. To increase access to pharmacy services in rural Western Australia some doctors have been granted a licence to dispense medication on the rationale that a pharmacy would not be economically viable in that community. However, there have been no studies conducted on whether a doctor dispensing service adequately provides a pharmacy service with respect to access and quality. METHOD: Residents of seven single pharmacy towns and seven non-pharmacy rural towns were surveyed to evaluate pharmacy services delivered by a pharmacist and doctor. The towns were chosen to match closely on key demographic features, with an average population of 1,246 and 1,263 respectively. A random sample of 150 households from each town was sent the questionnaire on pharmacy services (1050 in each group). Data was also collected from the Health Insurance Commission (HIC) on dispensing locations for the residents of the two groups of towns. RESULTS: There was a significant difference in access to pharmacy services with 82.4% of participants from pharmacy towns accessing medications within their town compared to 51.3% of non-pharmacy town participants. The HIC data supported these trends with pharmacy town residents having relatively higher prescription rates within their town compared to non-pharmacy town residents where they were more likely to access prescriptions out of their town. CONCLUSION: Pharmacy town participants were more satisfied with access to health and pharmacy services within their town. Continuation of the doctor dispensing policy requires a greater consideration of the pharmacy needs of rural residents

Stability of apomorphine in solutions containing selected antioxidant agents

Apomorphine in solution undergoes rapid autoxidation, producing greenish colored solutions, making it difficult to formulate as a stable pharmaceutical solution. To identify the optimum antioxidant agent/combination for apomorphine solution, a high performance liquid chromatography assay was used to study the stability of 50 µg/mL apomorphine HCI in 0.1% L-ascorbic acid (AA), 0.1% sodium metabisulfite (SMB), 0.1% EDTA, and in selected combinations at 25°C, 32°C, and 37°C over a period of 14 days. The stability of apomorphine HCl (10 mg/mL) in 0.1% AA solution and in 0.1% EDTA solution at 25°C and 37°C was also evaluated. Apomorphine HCI solution (50 µg/mL) in 0.1% AA plus 0.1% SMB solution retained 99.7% (at 25°C) and 95.9% (at 37°C) of the initial concentration, as 0.1% AA plus SMB solution minimized the reactive oxygen content in solution which, in turn, reduced the oxidation rate of apomorphine HCl, and there was no green coloration perceptible. Conversely, apomorphine HCl solution (50 µg/mL) in 0.1% SMB solution was unstable as only 0.53% (at 25°C) and 0.06% (at 37°C) of the initial concentration was retained after 14 days. All 10 mg/mL apomorphine HCl samples were stable in both studies. The initial concentration of apomorphine HCl solution markedly affected its rate of oxidation and discoloration. The addition of 0.1% AA to a current formulation of apomorphine HCl injection (Apomine(®)), which contains SMB as an antioxidant, was recommended as providing the most stable solution

Rural and Remote Pharmacy Workforce Development Program

Executive SummaryMany authors have commented upon the potential of pharmacies as a health promotion setting due to their ease of accessibility for the public, high level of use, and respected position of pharmacists.Research has demonstrated that pharmacist led health promotion can be successful in assisting people to make lifestyle changes around smoking, diet, and more specifically, lipid management. There is also preliminary evidence to suggest that pharmacists can provide physical activity and alcohol consumption recommendations to their customers.Presently pharmacists have mainly been involved in information provision and screening activities. This forms one component of a health promotion approach and particularly in rural regions, community pharmacies could be performing a greater role in community health promotion activities.A model was piloted in four rural pharmacies with each pharmacy provided with a small grant to cover community activities and in store health promotion advice provision. The primary researcher on the project offered consultation support to the pharmacies as well as conducting the literature review and project evaluation.Needs analyses were conducted in the pharmacies and feedback revealed a low level of interest in health behaviour topics although some customers mentioned an interest in receiving dietary advice. This reflected the lower use of the in-store component of the project with few customers utilising the free dietary checks. Falls prevention screening and diabetes screening were more popular.The pharmacies were able to organise and sponsor a wide range of health promotion community activities. These included workshops on health topics, physical activity programs, home reviews for falls prevention, and early years and school health promotion programs. These programs reached over 500 people across the four communities.The results showed the considerable potential for community pharmacies in rural areas to organise community health promotion activities. As well as the direct benefit to the people involved in these activities, having the pharmacy sponsor and organise the events contributes to changing the perceptions of the general public to realise the broad health expertise of pharmacies roles.Based on the literature review and findings of the project a model has been developed in the recommendations section to imbed health promotion within rural community pharmacies. Important aspects of this model are health promotion training for pharmacists and pharmacy assistants, provision of grant money support, consultation support from a health promotion worker and promotional material to advertise using the pharmacy for health promotion advice

Assessment of Western Australian sandalwood seeds for seed oil production

The Western Australian sandalwood (Santalum spicatum R.Br.) industry is transforming into an agro-forestry industry in which the seeds are being considered as a valuable secondary income generating product. Oil extracted from the seeds has a potential use in the cosmetic industry. This study aimed to identify the quality parameters for seeds to obtain oil of better and consistent quality, and the effect of seed source, seed size and storage time. Different seed samples varied in oil content, moisture content and fatty acid profile. Larger seeds from plantation trees in the wheatbelt region of Western Australia are the most suitable source of seed oil thus far evaluated. The seed grading system currently used by the sandalwood industry was suitable for selecting seeds from plantations (but not from natural stands in arid regions – ‘wild wood’) for seed oil production. Basic parameters for the selection of seeds for oil extraction were identified

A pilot study of cadre training to promote responsible self‐medication in Indonesia: Which is better specific or general modules?

In 2015, the Indonesian Government initiated ‘Smart Use of Medications Movement’ (‘GeMa CerMat’) which included cadre training to promote responsible self‐medication. Evaluation of a pilot training conducted across Indonesia suggested the need to improve those training modules. This study aimed to assess cadre’ knowledge gained following training with newly developed general or specific training modules. Five types of modules were developed and used to train cadres at five Community Health Centres (CHCs) in Surabaya, Indonesia: 1) Sidosermo CHC (general‐drugs module), 2) Tenggilis CHC (common cold drugs module), 3) Gunung Anyar CHC (analgesic drugs module), 4) Kalirungkut CHC (anti‐diarrhoeal drugs module), and 5) Jagir CHC (indigestion drugs module). Cadres’ knowledge improvements were evaluated using pre‐/post‐test scores and the difference scores depending on the module being tested. Multifactorial ANOVA explored the effects of the type of module on difference scores. A total of 279 cadres across five CHCs were involved in the training, giving response rates from 65% to 93%. There was an increase in the post‐test scores after the training with all modules. However, significant differences were reported only for the specific‐drugs module groups (all p < .001). Furthermore, the general module group had the lowest difference score (1.12; 95% CI [−0.45, 2.92]) while the common cold module group had the highest gain (5.02; 95% CI [1.95, 5.17]). Multifactorial ANOVA revealed that there was a significant main effect of the type of modules on difference scores [F (4, 263) = 8.37, p <.001]. In conclusion, this preliminary study indicated that the development of modules for specific minor illnesses could be beneficial in facilitating effective community‐based training to promote responsible self‐medication in Indonesia. The priority for therapeutic areas chosen for the module should be based on the local needs. Further research is required to confirm the findings in broader community members

An Expanded Prescribing Role for Pharmacists

Expanded pharmacist prescribing is a new professional practice area for pharmacists. Currently, Australian pharmacists’ prescribing role is limited to over-the-counter medications. This review aims to identify Australian studies involving the area of expanded pharmacist prescribing. Australian studies exploring the issues of pharmacist prescribing were identified and considered in the context of its implementation internationally. Australian studies have mainly focused on the attitudes of community and hospital pharmacists towards such an expansion. Studies evaluating the views of Australian consumers and pharmacy clients were also considered. The available Australian literature indicated support from pharmacists and pharmacy clients for an expanded pharmacist prescribing role, with preference for doctors retaining a primary role in diagnosis. Australian pharmacists and pharmacy client’s views were also in agreement in terms of other key issues surrounding expanded pharmacist prescribing. These included the nature of an expanded prescribing model, the need for additional training for pharmacists and the potential for pharmacy clients gaining improved medication access, which could be achieved within an expanded role that pharmacists could provide. Current evidence from studies conducted in Australia provides valuable insight to relevant policymakers on the issue of pharmacist prescribing in order to move the agenda of pharmacist prescribing forwards