IRELAND’S OFFICIAL PHARMACY PUBLICATION
MARCH 2019
CPD: Alopecia Economic backdrop for pharmacy sector Inhaler Technique Asthma Society and IPU launch awareness campaign
IPU CONFERENCE – EARLY BIRD DEADLINE | EPILEPSY IRELAND TAILOR MADE JUST FOR YOUR PHARMACY
A bespoke retail review of your front- of-pharmacy will give your pharmacy a facelift to boost your sales without overstretching your budget. Our One-Day Review will include: How we have ■ Expert advice on your retail o ering helped ... ■ A complete review of the front-of-pharmacy including category management and promotion planning Perhaps the most e ective ■ Providing training in sales techniques part of the process was the ■ Re-merchandising displays (interior and window) to explanation given to the teams in enhance the retail experience in your pharmacy store, the ownership they took of ■ Helping you and your sales team develop new sales ideas the ideas discussion and the speed ■ Using key performance indicators to help you of implementation of the change, increase front-of-pharmacy business which thankfully produced the ■ Motivating your sales team to be innovative, expected results. sales focused and up-to-speed on product knowledge Tom Murray, Murray’s Pharmacy, Co. Donegal Darren Kelly, IPU Business Development Manager, has over 20 years of retail experience. If you would like further information on this service or would like to book a Retail Review, please contact Darren on (01) 493 6401 / 086 028 9825 / email: [email protected]
Retail Review A4 2017 ART.indd 1 02/05/2017 16:50 MARCH 2019
07 A Note from the Editor
IPU News The latest news and events from Butterfield House 08 Dates for your Diary 16 08 Pharmacy in the media 10 IPU Conference – Early Bird Deadline The IPU Review is published monthly and circulated to Irish 10 Operation Transformation – Thank you pharmacists. The views expressed 12 Urgent progress needed on resourcing by contributors are not those healthcare in the community of the IPU nor is responsibility accepted for claims in articles 14 Member Briefings – March 2019 or advertisements. 14 Congratulations Subscription: €100 (Ireland North & South) and €150 (including postage overseas).
Publisher: Irish Pharmacy Union (IPU Services Ltd), Butterfield House, Butterfield Avenue, Rathfarnham, Dublin 14, D14 E126 Tel: (01) 493 6401 Fax: (01) 493 6626 Email: [email protected] Website: www.ipu.ie Editor: Jack Shanahan MPSI Editorial Associates: Features Sinéad Fennell, Ciara Browne and Jim Curran 16 Economic backdrop for pharmacy sector Advertising: Sinéad Fennell Email: [email protected] Tel: (01) 493 6401 22 A community pharmacy-based pilot project for BowelScreen ©2019 Copyright: All Rights Reserved, Irish Pharmacy Union. 34 Printed by Ryson Colour Printers Ltd. 25 IPU Conference IPU Review is a Registered Trademark of the Irish Pharmacy Union. 30 Asthma Society of Ireland 34 An Analysis of the Pharmacist Workforce Capacity in Ireland 30
IPUREVIEW MARCH 2019 3 NEED HELP WITH THE HSE?
THE IPU CONTRACT UNIT IS HERE TO HELP YOU
CONTACT DEREK OR AOIFE For advice on any part of the pharmacy contract; For advice on all aspects of processing claims; For assistance in responding to direct correspondence from the HSE PCRS; If you are called to a meeting with the HSE PCRS; If your pharmacy is inspected by the HSE PCRS; If you are subject to a claims investigation; and If you are being investigated under the pharmacy contract.
Telephone: 01 406 1557 / 01 493 6401 Derek Reilly, Contract Manager, [email protected] Aoife Garrigan, Contract Administrator, [email protected]
PCRS Claims 2019 ART.indd 1 24/01/2019 16:57 NEED HELP 39 Behaviour & Attitudes: 48 Reframing Community WITH THE HSE? Pharmacy 43 Epilepsy Ireland – Purple Day 26 March 45 CPD: Alopecia 48 Assisted Decision-Making (Capacity) Act 2015 51 Report of PSI Council Meeting of 14 February 2019 News 53 Politics 66 PSI Strategy 2018 – 2020 57 Obituary: Pádraig Ó Mathúna 67 IMVO – EU Falsified Medicines Directive (FMD) 58 Studies 68 HIQA announces public consultation on C-reactive protein point-of-care testing 60 High Tech Medicines Update: 69 National Cancer Strategy 2017 – 2026 Implementation Report 2018 Symkevi® Film-coated Tablets 70 Irish Skin Foundation Dermatology Study 61 Clinical Tips: Restrictions Day 2019 – 6 April 2019 70 Cystic Fibrosis Ireland to host on the use of Quinolone and national conference Fluoroquinolone Antibiotics 70 9th All Ireland Pharmacy Conference THE IPU CONTRACT UNIT – Call for Abstracts 62 International Pharmacy News 71 Accord Healthcare launches High Tech IS HERE TO HELP YOU Hub Demo Video with PharmaBuddy 64 Product Information 71 Daffodil Day more important than ever CONTACT DEREK OR AOIFE 72 Ministers for Health and Agriculture publish report on antimicrobial use and resistance For advice on any part of the pharmacy contract; 72 Over 600 life-saving defibrillators across four manufacturers require urgent updates For advice on all aspects of processing claims; 73 Minister for Health appoints HSE Board For assistance in responding to direct correspondence from the HSE PCRS; 73 FSAI publishes updated guidelines If you are called to a meeting with the HSE PCRS; 74 Irish Chemists’ Golfing Society News If your pharmacy is inspected by the HSE PCRS; 74 Classifieds If you are subject to a claims investigation; and If you are being investigated under the pharmacy contract.
Telephone: 01 406 1557 / 01 493 6401 Derek Reilly, Contract Manager, [email protected] Aoife Garrigan, Contract Administrator, [email protected] 45 IPUREVIEW MARCH 2019 39 5
PCRS Claims 2019 ART.indd 1 24/01/2019 16:57 IPU PRODUCT FILE
The IPU Product File has been in existence for more than 30 years and is an indispensable resource for community pharmacists. It was designed for pharmacists by pharmacists and is also used by doctors and hospital personnel. It is a vital support tool for prescribing, dispensing, claiming with PCRS, stock ordering, stock taking, price checking and product sourcing.
What is in the File? ISO Certified The File contains information on over 63,000 products, including: In 2016, the IPU Product File achieved ISO Certification for 9001 (Quality) and 27001 (Information Security). Licensed medicinal products ISO 9001 ISO 27001 The audit and certification process for ISO Certification Registered Registered Quality Information Security Unlicensed medicinal products emphasises the robustness of the IPU Product File and Management Management underpins its position as the definitive medicinal product Medical devices and sundries (bandages, dressings, ostomy equipment etc.) catalogue in Ireland. Nutritional products, including foods for special diets Easy to Use Veterinary products The IPU Product File is an open system, so no matter what vendor you choose, Photographic products the file can be adapted for your needs. The IPU Product File is available by Cosmetic products electronic download, where you can log-in and download your monthly update.
Front of Shop products (shampoos, toothpastes, vitamins etc.) Contact Us In addition to pricing information, barcodes etc., the IPU Product File The IPU Product File team are available to answer your queries, whether it’s provides valuable professional information on health products. The professional on sourcing a product, pricing queries etc., the team will be able to assist you. information provided includes the Medicinal Product Name, PA/EU number, For any queries relating to the IPU Product File, please contact a staff member Generic Name, Pharmaceutical Form, Strength and Legal Status. on 01 406 1550 or [email protected] A NOTE FROM THE EDITOR Jack Shanahan MPSI No computer can take the place of a professional taking a IPU PRODUCT FILE compassionate and professional The IPU Product File has been in existence for more than 30 years and is an indispensable resource for community pharmacists. It was designed for pharmacists by pharmacists and is also used by doctors decision to avoid or minimise harm and hospital personnel. It is a vital support tool for prescribing, dispensing, claiming with PCRS, stock ordering, stock taking, price checking and product sourcing. One of the major societal issues facing us is the twin prongs of workplace and work evolution. While nobody has a crystal ball, the growth of artificial intelligence and self-styled expert systems are making many categories of workers nervous.
n the face of always deliver optimal care. yes and no. This begs the offering. One of the major it, pharmacists In addition, we now have the question that arose earlier. annoyances that I endured should not be growth of remote prescription If a pharmacist is simply an in the trial was the niggle of sleeping too well writing services, where the effector of a set of rules, then having to log-in every three at night. And this person signing the prescription why not replace them with hours. It says something about would be true if you took a will never examine, not to a machine? The technology the quality of the product veryO functional look at some mind meet the patient under is there. Dispensing robots that this was my biggest of our labours. It is evident their care. And to cap it all, we are in many towns in Ireland. issue. So, what did they do? that some of our processes have the arrival of ‘drop in’ As electronic prescriptions They made everybody log-in can be automated. It would clinics, large and small, where become the norm, then there every hour with the release be fair to say that our Achilles you will see an Irish registered is an obvious progression. version. Genius. It was no great Heel is the perception that doctor, but with few of the The reality is that there are consolation as I compared my our work is simply seen as a benefits of an overview of your times when it is necessary for setup with others. Of those supply function. Yet, on any clinical history. All reasons pharmacists to break the law, that had a working system, it given day, while safe medicine why you need a professional purely in the patient’s best was clear, with two notable supply is important, we are pharmacist acting in the best interest. These are exceptional exceptions, that consultation not automatons. We are interest of the patient. circumstances. But they exist. with end-user needs was professionals, exercising our This is exactly what our And no computer can take minimal. In many cases, you judgement about where the code of conduct demands of the place of a professional actually have to scan twice. patient benefits and risks lie. us. The revised version, while taking a compassionate and Life is too short for these Even in the idyllic pastures varying in emphasis, still has professional decision to avoid poorly designed and rushed and gently rolling verdant hills this overarching concept at or minimise harm. FMD packages. Demand more. of the Kingdom, the winds its core. For instance, the old FMD day passed with a of primary care change are chestnut, are pharmacists splutter and a phut: nobody blowing steadily. allowed to break the law? died and some actually had a Part of this is the gradual More specifically, are there working system in place by 9 erosion and fragmentation times when, in a professional February. As anticipated, plain of the traditional GP-patient capacity, we are expected sailing was not the order of the relationship. As we move to to supply controlled drugs day. On a very positive note, large primary care centres, outside legislative parameters? the powers that be decided on anonymity starts to follow. But As we all should know, the a soft rollout. This meant that What is in the File? ISO Certified this is only a minor part of the legislation is very clear. There all medicines, in the initial The File contains information on over 63,000 products, including: In 2016, the IPU Product File achieved ISO Certification challenge. Above all else is the are no circumstances where period, are supposed to scan for 9001 (Quality) and 27001 (Information Security). sheer volume of work faced you can supply a CD2/3/4.1 green. This does not mean that Licensed medicinal products ISO 9001 ISO 27001 The audit and certification process for ISO Certification Registered Registered by most GP practices. Most drug, with the honourable they all have a pass, in that Quality Information Security exception of phenobarbitone/ if you adjudge a medicine to Unlicensed medicinal products emphasises the robustness of the IPU Product File and Management Management patients, and pharmacists, can underpins its position as the definitive medicinal product attest to the sheer difficulty phenobarbital in epilepsy, be suspicious, you should act. Medical devices and sundries (bandages, dressings, ostomy equipment etc.) catalogue in Ireland. in getting a GP practice to without a valid prescription. This is, of course, what would Nutritional products, including foods for special diets even answer the phone. Most So, there it is. Black and white. have happened previously. As I Easy to Use routine GP prescriptions are Can’t be done. This is, of had done beta testing with one Veterinary products on a conveyor belt system. course, the answer that any specific supplier, I decided to The IPU Product File is an open system, so no matter what vendor you choose, computer can give. Technology throw my lot in with them for Photographic products This has meant an increasing the file can be adapted for your needs. The IPU Product File is available by dependence on processes, is the master of the binary going live. It would be fair to Cosmetic products electronic download, where you can log-in and download your monthly update. many of which, with the question, with everything say that I wasn’t particularly best will in the world, don’t coded in noughts and ones, enamoured with the live Front of Shop products (shampoos, toothpastes, vitamins etc.) Contact Us In addition to pricing information, barcodes etc., the IPU Product File The IPU Product File team are available to answer your queries, whether it’s If you have any comments, queries or issues to raise, send provides valuable professional information on health products. The professional on sourcing a product, pricing queries etc., the team will be able to assist you. your “Letters to the Editor” by email to [email protected]. information provided includes the Medicinal Product Name, PA/EU number, For any queries relating to the IPU Product File, please contact a staff member Generic Name, Pharmaceutical Form, Strength and Legal Status. on 01 406 1550 or [email protected] IPUREVIEW MARCH 2019 7 Pharmacy in We’re making it even easier the Media to nd unlicensed medicines. At the end of January, pharmacy students rallied outside the Dáil in protest at unpaid work placements. We were there to show our support to the students; there was They’re now just a click away. media coverage on RTÉ Radio 1 and Darragh O’Loughlin was quoted in The Irish Times. We were mentioned in the Irish Daily Star regarding the DPS Scheme and on Fora.ie regarding the new FMD legislation. We were mentioned in the Mail on Sunday ahead of the shop.medisource.ie launch of Operation Transformation’s nationwide Weigh Your Age campaign and our involvement this year. The campaign was announced on the programme on RTÉ One on Wednesday 6 February. There was significant national media around the campaign including The Medisource is delighted to introduce Irish Times, Irish Independent, The Herald and on RTÉ.ie. IPU member Sarah Breslin was quoted for an article our new online ordering system in the Lifestyle section of the Irish Independent and for exempt medicinal products. there was coverage in the Donegal Democrat. Ann Marie Dates for Horan was also on RTÉ One’s Claire Byrne Live to discuss Pharmacists can register for online the campaign. There was a segment on Operation access at shop.medisource.ie your Diary Transformation on 13 February to show footage from some of the pharmacies. MARCH 2019 There was also coverage on RTÉ.ie, in two articles in ■ Real-time stock information World Glaucoma the Irish Examiner, and in the Irish Daily Mirror regarding 10 – 16 March Week, www.world the IPU’s objection to VAT on food supplements. ■ Easy search lter glaucomaweek.org/t National Brain ■ Tracking of online order history 11 – 17 March Awareness Week, www.nai.ie/go/brain_ ■ Fast re-order option awareness_week ■ Relevant product details e.g. HSE code, IPU Member Briefings 19 – 28 March Fridge item, Foreign pack Daffodil Day, 22 March www.cancer.ie ■ No fax requirement
World TB Day, 24 March www.stoptb.org Purple Day, Epilepsy 26 March Ireland, www.epilepsy.ie
Early Bird Deadline 29 March for IPU conference, www.pharmacy conference.ie
APRIL 2019 Bowel Cancer Awareness Month www.cancer.ie ISF Dermatology Study 6 April Day, www.irishskin.ie
65 Roses Day 12 April (Cystic Fibrosis), www.bit.ly/65Roses2019 The rst dedicated and No. 1 supplier of unlicensed or di cult to get medicines in Ireland. Medisource is Irish-owned and has a team of pharmacist-led experts to deal with your enquiries.
8 IPUREVIEW MARCH 2019 www.medisource.ie | Call 1890 2866366 | Fax 01 2866288 | Email [email protected]
Medisource A4 Flyer ART.indd 1 25/02/2015 11:27 We’re making it even easier to nd unlicensed medicines. They’re now just a click away. shop.medisource.ie
Medisource is delighted to introduce our new online ordering system for exempt medicinal products. Pharmacists can register for online access at shop.medisource.ie
■ Real-time stock information ■ Easy search lter ■ Tracking of online order history ■ Fast re-order option ■ Relevant product details e.g. HSE code, Fridge item, Foreign pack ■ No fax requirement
The rst dedicated and No. 1 supplier of unlicensed or di cult to get medicines in Ireland. Medisource is Irish-owned and has a team of pharmacist-led experts to deal with your enquiries.
www.medisource.ie | Call 1890 2866366 | Fax 01 2866288 | Email [email protected]
Medisource A4 Flyer ART.indd 1 25/02/2015 11:27 IPU NEWS
WEIGH IPU Conference YOUR – Early Bird AGE As part of Operation Transformation, have your Deadline metabolic age, visceral fat, fat percentage and weight checked FOR FREE in this Pharmacy on The IPU National Pharmacy Conference is the ‘go-to’ event for community pharmacists in Ireland. The 9th 7 February 2019 annual conference will take place on 10 – 12 May 2019 in the Galmont Hotel, Galway. IPU Members can avail SUPPORTED BY of a special Early Bird Rate – book before 29 March to secure the discounted rate. The range of events held over the weekend ensures that there is something for everyone at this year’s conference. The conference is open to all registered pharmacists, as well as pharmacy staff and owners who are members of the IPU, and Pharmacy Interns. 10 educational sessions will be held over the Operation weekend, providing you with the opportunity to enhance your skills, differentiate yourself from your peers and help you to stay up-to-date with current Transformation issues. The clinical sessions will focus on supporting a range of patients, thus improving patient outcomes and bettering the health of the communities you serve. – Thank you to Turn to pages 25-29 for more information about our 10 CPD sessions, along with a booking form you can use to all involved book your place. Your conference ticket gets you unlimited access to We want to thank all of you who took part all the sessions, as well as the Exhibition Hall, Panel in last month’s Operation Transformation Discussion and Plenary Session. You can find full details Weigh Your Age campaign. It was a huge of the conference at www.pharmacyconference.ie. success and participating pharmacies were The Early Bird rate, available to IPU Members, is very busy all day. From feedback we have only €100. Sign-up and save before 29 March. received from members, there was a great turnout in pharmacies and members were very happy with how everything went.
10 IPUREVIEW MARCH 2019 Hi Tech Portfolio
ANTI-BACTERIAL AGENT NEUTROPENIA Linezolid Accofil▼ Linezolid Filgrastim
600 mg x 10 Film Coated Tablets 30 MU/0.5 ml Solution for Injection / Infusion in Pre-Filled Syringe x 5 48 MU/0.5 ml Solution for Injection / Infusion in Pre-Filled Syringe x 5 ANTI-FUNGAL AGENT Voriconazole Accord Pelgraz ▼ Voriconazole Pegfilgrastim WEIGH 6 mg Solution for Injection 50 mg x 28 Film Coated Tablets in Pre-Filled Syringe x1 200 mg x 28 Film Coated Tablets YOUR PULMONARY ARTERIAL HYPERTENSION ANTI-VIRAL AGENT Granpidam AGE Valganciclovir Sildenafil Valganciclovir 20 mg x 90 Film Coated Tablets As part of Operation Transformation, have your metabolic age, visceral fat, fat percentage and weight 450 mg x 60 Film Coated Tablets ONCOLOGY AGENT checked FOR FREE Bicalutamide in this Pharmacy on 7 February 2019 IMMUNOSUPPRESSANT Bicalutamide Mycophenolate 50 mg x 28 Film Coated Tablets SUPPORTED BY Mofetil Accord Mycophenolate Mofetil Capecitabine Accord Capecitabine
250 mg x 100 Capsules 150 mg x 60 Film Coated Tablets 500 mg x 50 Film Coated Tablets 300 mg x 60 Film Coated Tablets 500 mg x 120 Film Coated Tablets HIV-1 INFECTION AND HEPATITIS B INFECTION Imatinib Accord Tenofovir disoproxil Imatinib Tenofovir disoproxil 100 mg x 60 Film Coated Tablets 400 mg x 30 Film Coated Tablets 245 mg x 30 Film Coated Tablets
HEPATITIS B INFECTION Temozolomide Accord Temozolomide Entecavir (Actavis) 5 mg x 5 Hard Capsules Entecavir 20 mg x 5 Hard Capsules 100 mg x 5 Hard Capsules 0.5 mg x 30 Film Coated Tablets 140 mg x 5 Hard Capsules 180 mg x 5 Hard Capsules 250 mg x 5 Hard Capsules
Further information is available on request from Accord Healthcare Ireland Ltd, Euro House | Euro Business Park | Little Island | Cork | T45 K857 | Ireland. Tel: 021-461 9040 or from the SmPC available on www.accord-healthcare.ie Products subject to prescription. Supply through pharmacies only. Marketing Authorisation Holder for Actavis products Actavis Group PTC ehf, Reykavikurvegi, 76-78, 220 Hafnarfjordur, Iceland and for Accord products Accord Healthcare Limited, Sage House, 319 Pinner Road, North Harrow, Middlesex HAI 4HF, United Kingdom. Date of Preparation: September 2018 UK&IE/HiT/0002/10-17a IPU NEWS Urgent progress needed on resourcing healthcare in the community
The Government faces increasing and often competing Services which the IPU recommend rolling out to Irish demands from across the healthcare industry. In the face of pharmacies include: these pressures the IPU has urged the Government to remain n Minor Ailment Scheme focussed on their primary care objectives and to deliver new This scheme would enable medical card patients receive and efficient ways to treat patients in their communities. treatment for common illnesses such as hay fever, There are over 1,800 community pharmacies nationwide migraine or skin conditions free of charge direct from and the range of services they provide could be significantly their local pharmacy. Currently medical card patients enhanced. However, according to the IPU, the Government are required to visit a GP and obtain a prescription has consistently failed to progress a series of common-sense for treatments ordinarily available over the counter. proposals, creating missed opportunities for patients and the Implementing this scheme prevent the requirement for system as whole. up to 950,000 GP consultations each year. Darragh O’Loughlin, Secretary General of the IPU said, “Community pharmacy is the most accessible part of our n New Medicine Service healthcare system, with four out of five members of the public A structured pharmacy-led monitoring service for visiting a pharmacy at least once a month. It is clear that our patients on newly prescribed medications for long-term patients want to avail of more services from the convenience illnesses including COPD and Type 2 Diabetes. A pilot of their local pharmacy, but a lack of action from Government in Ireland has already shown this improves ‘optimal is consistently preventing us from doing so. Crucially, there adherence’ to medications and could bring savings to the are many people currently being treated by GPs, who could be health system. treated in pharmacies. GP practices are already under severe n pressure, with many reportedly unable to take on new patients. Chronic Disease Management With GPs overwhelmed, it makes absolute sense to expand Envisaged as a collaborative initiative between GPs, the scope of services provided by community pharmacists, Pharmacists and other healthcare providers this scheme which will reduce the burden on this overstretched part of the would see pharmacists would monitor important health healthcare system.” indicators and refer any concerns to GPs. A pharmacy- based blood pressure management service could for example save the state €1.36bn over 30 years. “Irish pharmacists are ready, willing and waiting to enhance the levels of care they provide,” said Darragh O’Loughlin. “Unfortunately, time and again, despite all the successful pilots and studies, community pharmacists’ positive intentions and desire to help patients is left to gather dust on a shelf.” Darragh O’Loughlin concluded that, “The time is right to optimise our delivery of primary care by providing appropriate convenient, accessible and cost-effective healthcare through pharmacies in communities throughout the country. Patients cannot afford to wait.”
12 IPUREVIEW MARCH 2019 Utilizzati 2 Colori Pantone:
P. 424 C P. 296 C
RELIFE. MY SKIN SAYS HOW I FEEL
Colore:
P. 296 C IR-REL-01-2019 FEB 2019 IR-REL-01-2019
Relife advert._final.indd 1 15/02/2019 14:11 IPU NEWS Member Briefings Congratulations
– March 2019 Congratulations to Alma Barr, Education Coordinator, IPU, who gave birth to a baby boy The IPU will be holding a series of member briefings in the last month. We wish Alma and Jonathan all the last two weeks of March (see details below) to update you on all best with their new arrival! relevant current issues and to hear your views. Issues to be discussed will include the following: n Current position regarding FEMPI; n Falsified Medicines Directive / medicines authentication; n Brexit; n PCRS issues; n Political lobbying campaign; and n Any other issues arising.
Region Venue Time Date Cork The Oriel House Hotel 8.00pm 19 March Ballincollig, Co. Cork
Limerick The Strand Hotel 8.00pm 20 March Ennis Road, Limerick City
Kilkenny Newpark Hotel 8.00pm 21 March Castlecomer Road, Kilkenny
Sligo Clayton Hotel 8.00pm 25 March Clarion Road, Ballytivnan, Sligo
Athlone Hodson Bay Hotel 8.00pm 26 March Roscommon Road, Athlone
Galway Maldron Hotel Sandy Road 8.00pm 27 March (Formerly the Pillo Hotel) Headford Road, Galway
Dublin Crowne Plaza Hotel 8.00pm 28 March Blanchardstown, Dublin 15
GET THE RETAIL FACTOR IN YOUR PHARMACY. For further information on the IPU Retail Review service, please contact Darren Kelly on (01) 493 6401 / 086 028 9825 or email: [email protected]
IPU Retail Banners 190X45 MAR16 ART.indd 4 25/03/2016 17:55
14 IPUREVIEW MARCH 2019 DON’T LET PAIN HOLD YOU BACK
ESSENTIAL INFORMATION
Solpa-Extra 500mg/65mg Soluble Tablets contain paracetamol and caffeine. For the treatment of mild to moderate pain. Adults and children over 16 years: 1-2 tablets dissolved in water every 4-6 hours. Max 8 tablets a day. Children 12-15 years: 1 tablet disolved in water every 4-6 hours. Max 4 tablets a day. Not suitable for children under 12 years. Contraindications: Hypersensitivity to the ingredients. Precautions: Particular caution needed under certain circumstances, such as renal or hepatic impairment, chronic alcoholism and malnutrition or dehydration. Precautions needed in asthmatic patients sensitive to acetylsalicylic acid, patients on a controlled sodium diet and with rare hereditary problems of fructose intolerance. Patients should be advised not to take other paracetamol containing products concurrently. Pregnancy and lactation: Not recommended during pregnancy and breastfeeding. Side effects: Rare: allergies. Very rare: thrombocytopenia, anaphylaxis, bronchospasm, hepatic dysfunction, cutaneous hypersentitivity reactions. Unknown: nervousness, dizziness. Further information is available in the SmPC. PA 1186/017/001. P. MAH: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. Date of preparation: April 2017.
Solpa-Extra New KV A4 Trade Ad.indd 1 01/02/2019 18:14 BUSINESS Jim Power, Economist Economic backdrop for pharmacy sector
Trading conditions for the The pharmacy sector in 2018 Trading conditions for the sales increased by 17.1%, but pharmacy sector continued pharmacy sector continued the value of sales increased to gradually improve in 2018 by a more modest 6.6%. This to gradually improve in 2018 in line with most other parts suggests that the pharmacy in line with most other parts of the economy. Sales of sector is still dealing with Pharmaceutical, Medical and a financially pressurised of the economy. Sales of Cosmetic items increased by consumer sector, with the 1.5% in value terms in 2018 ability to convert volume Pharmaceutical, Medical and and by a much stronger 5.5% growth into value growth still in volume terms. Between challenging. Cosmetic items increased by 2015 and 2018, the volume of 1.5% in value terms in 2018 and by a much stronger 5.5% in volume terms.
16 IPUREVIEW MARCH 2019 On the price side, Figure 1: Retail Sales of Pharmaceutical, Medical & Cosmetic Items compression is still a feature of the market. In 2018, the average consumer price of pharmaceutical products was 3.4% lower than the previous year and 10.5% lower than 2008; the average price of prescribed drugs declined by 5.3% in 2018 and was 19.7% lower than 2008; and the average price of other medicines declined by 0.1% in 2018, but prices were 1.8% higher than 2008.
The economy in 2018 The Irish economy performed strongly in 2018, with almost all indicators of economic Source: CSO activity continuing to suggest solid levels of economic momentum. Figure 2: Consumer Price of Pharmacy Products GDP growth Quarterly national accounts data are available for the first nine months of 2018 and show that in the first three quarters of the year, real gross domestic product (GDP) expanded by 7.4% and real gross national product (GNP) expanded by 7.5%. Personal consumption increased by 3.1% and exports of goods and services expanded by 9.2%. Modified domestic demand expanded by 4.5%. This is an indicator of domestic demand where globalisation effects, such as trade in intellectual property products and trade in aircraft by leasing companies, are excluded. This is a more accurate representation of what happened on the ground Source: CSO in the real economy in 2018 and it describes an economy that experienced steady rather the fact that personal finances in 2008 but it has plateaued spending, but rather reflects than dramatic growth as the are still stretched due to low over the past three years and the financial strains that GDP and GNP growth rates wage growth for the past is proving quite volatile from continue to pressurise the might appear to suggest. decade; a high personal tax month to month. In October, personal sector. burden; uncertainty relating confidence dipped to a Consumer dynamics to the impact of Brexit; and 46-month low but it improved Labour market In 2018, the volume of retail rapidly escalating house prices modestly in January. In the year to September sales expanded by 3.8% but and rents that are soaking up Issues such as Brexit, 2018, the number of people the growth in value terms was disposable income, leaving rapidly escalating house in employment increased by lower at 2.7%. The persistent less money available for other prices and rents, higher fuel 66,700 or 3% to reach 2.273 gap between volume and discretionary spending. The costs, the high personal tax million. This is the highest value growth reflects the fact retail market is challenging, burden, and subdued wage level of employment ever that retailers are still dealing with the growth in online growth are combining to achieved in Ireland. The with a personal sector that is purchasing also a significant have a somewhat sobering growth in employment is resistant to higher prices and business challenge. influence on the personal broadly based from a sectoral is continuously in search of Consumer confidence sector. However, this is not perspective, and unlike the value for money. This cautious recovered strongly in the indicative of an impending years leading up to 2007, it is consumer behaviour is due to aftermath of the recession sharp correction in consumer not being driven primarily by
IPUREVIEW MARCH 2019 17 Figure 3: Consumer Confidence The public finances The Government recorded an Exchequer surplus of €106 million in 2018. This is the first budget surplus since 2006. The improvement in the public finances is due to tax revenue buoyancy rather than any serious efforts to control public expenditure. For the year as a whole, the Exchequer collected €55.6 billion in taxation, which is the highest level of tax revenues ever collected. Tax revenues continued to grow strongly in January and were 7% ahead of January 2018. An Exchequer surplus of €1.64 billion was recorded in January.
The outlook for 2019 Source: ESRI/KBC Bank The outlook for the Irish economy in 2019 looks reasonably good but the risks Table 1: Employment Growth by Sector Q3 2012 – Q3 2018 the construction sector and and challenges are clear. related activities. This makes As 2018 progressed, the Sector Q3 2012 Q3 2018 Change it look more sustainable. external environment did (000S) (000S) In the year to January 2019, give cause for concern. the number of people officially Growth in the Euro Zone lost Agriculture 110.1 104.9 -5,200 registered as unemployed considerable momentum; declined by 13,400, to reach a number of emerging Industry 232.8 284.6 +51,800 127,300. The unemployment economies, such as Brazil, rate stood at 5.3% of the Construction 82.8 146.5 +63,700 Argentina, Venezuela labour force in January, which and Turkey, experienced Retail & Wholesale 276.6 301.0 +24,400 is down from 16% at the considerable economic and beginning of 2012. political difficulties; UK Transportation 83.4 101.2 +17,800 growth was undermined by Tourism Brexit-related uncertainty Accommodation & 127.4 181.2 +53,800 The tourism performance and China lost considerable Food Services continues to be very strong. momentum. The US was the ICT 91.2 124.1 +32,900 In 2017, 9.93 million overseas most notable exception, as visitors came to Ireland, the tax package implemented Financial Services 103.6 101.3 -2,300 which is the highest level ever a year ago gave a significant recorded. The strong tourism boost to economic activity. Professional & 106.5 135.4 +28,900 performance continued in As we look ahead to 2019, Scientific 2018. 10.6 million overseas many of the signs are pointing Admin & Support 79.7 105.4 +25,700 visitors came into the country, towards a more challenging Services which is 6.9% ahead of 2017. year for the global economy Visitor numbers from Great and global geopolitics. It is Public Admin & 89.3 104.1 +14,800 Britain increased by 0.8% unlikely that global recession Defence to reach 3.76 million, and will be experienced, but accounted for 35.4% of total global growth looks set to be Education 134.2 170.6 +36,400 overseas visitor numbers. This somewhat slower than in 2018 Health 258.4 282.1 +23,700 is down from 40.9% in 2016. and there are considerable Sterling weakness and slower risk factors that will need to TOTAL 1,887.0 2,273.2 +386,200 UK growth have impacted be watched closely. on this market segment. n Source: CSO, Labour Force Survey, 20 November 2018 Visitor numbers from North US growth is likely to America increased by 13.4% ease over the coming to reach 2.38 million; and months, as the fiscal visitor numbers from the rest stimulus package of Europe, excluding Great introduced a year ago Britain, increased by 9.5% to dissipates. To date, the reach 3.81 million.
18 IPUREVIEW MARCH 2019 INVOKANA® (canagliflozin) 100 mg & 300 mg film-coated Uncontrolled INVOKANA is indicated for the treatment tablets. PRESCRIBING INFORMATION. Republic of Ireland. Please refer to Summary of Product Characteristics (SmPC) before of adults with insufficiently controlled prescribing. INDICATIONS: The treatment of adults with insufficiently type 2 diabetes mellitus (T2DM) as an controlled type 2 diabetes mellitus as an adjunct to diet and exercise blood sugar adjunct to diet and exercise.1 as monotherapy when metformin is considered inappropriate due to intolerance or contraindications, or in addition to other medicinal products for the treatment of diabetes. DOSAGE & ADMINISTRATION: Adults: can’t wait recommended starting dose: 100 mg once daily. In patients tolerating this dose and with eGFR ≥ 60 mL/min/1.73 m2 needing tighter glycaemic control, dose can be increased to 300 mg once daily. Caution increasing dose in patients ≥ 75 years old, with known cardiovascular disease or for whom initial canagliflozin-induced diuresis is a risk. Correct volume depletion prior to initiation. When add-on, consider lower dose of insulin or insulin secretagogue to reduce risk of hypoglycaemia. For oral use, swallow whole. Children: no data available. Elderly: consider renal function and risk of volume depletion. Renal impairment: not to be initiated with eGFR < 60 mL/min/1.73 m2. If eGFR falls below this value during treatment, adjust or maintain dose at 100 mg once daily. Discontinue if eGFR persistently < 45 mL/min/1.73 m2. Not for use in end stage renal disease or patients on dialysis. Hepatic impairment: mild or moderate; no dose adjustment. Severe; not studied, not recommended. CONTRAINDICATIONS: Hypersensitivity to active substance or any excipient. SPECIAL WARNINGS & PRECAUTIONS: Not for use in type 1 diabetes. Renal impairment: eGFR < 60 mL/min/1.73 m2: higher incidence of adverse reactions associated with volume depletion particularly with 300 mg dose; more events of elevated potassium; greater increases in serum creatinine and blood urea nitrogen (BUN); limit dose to 100 mg once daily and discontinue when eGFR < 45 mL/min/1.73 m2. Not studied in severe renal impairment. Monitor renal function prior to initiation and at least annually. Volume depletion: caution in patients for whom a canagliflozin-induced drop in blood pressure is a risk (e.g. known cardiovascular disease, eGFR < 60 mL/min/1.73 m2, anti- hypertensive therapy with history of hypotension, on diuretics or elderly). Not recommended with loop diuretics or in volume depleted patients. Monitor volume status and serum electrolytes. Haematocrit: careful monitoring if already elevated. Genital mycotic infections: risk in male and female patients, particularly in those with a history of GMI. Lower limb amputation: Consider risk factors before initiating. Monitor patients with a higher risk of amputation events. Counsel on routine preventative foot care and adequate hydration. Consider discontinuing Invokana when events preceding amputation occur (e.g. lower-extremity skin ulcer, infection, osteomyelitis or gangrene). Urine laboratory assessment: glucose in urine due to mechanism of action. Lactose intolerance: do not use in patients with galactose intolerance, total lactase deficiency or glucose-galactose malabsorption. Diabetic ketoacidosis (DKA): rare DKA cases reported, including life-threatening and atypical presentation cases. Where DKA is suspected or diagnosed, discontinue Invokana treatment immediately. Interrupt treatment in patients who are undergoing major surgical procedures or have acute serious medical illnesses. Consider risk factors for development of DKA before initiating Invokana treatment. SIDE EFFECTS: Very common (≥1/10): hypoglycaemia in combination with insulin or sulphonylurea, vulvovaginal candidiasis. Common (≥1/100 to <1/10): constipation, thirst, nausea, polyuria or pollakiuria, urinary tract infection (including pyelonephritis and urosepsis), balanitis or balanoposthitis, dyslipidemia, haematocrit increased. Uncommon (<1/100) but potentially serious: anaphylactic reaction, diabetic ketoacidosis, syncope, hypotension, Lower HbA1c levels orthostatic hypotension, urticaria, angioedema, bone fracture, renal failure (mainly in the context of volume depletion), lower limb amputations In patients with HbA1c higher than 9%, INVOKANA reduces HbA1c by (mainly of the toe and midfoot, incidence rate of 0.63 per 100 subject- 3 years, vs 0.34 for placebo). Refer to SmPC for details and other side 1.57% and 1.80% with its 100mg and 300mg doses respectively. effects. PREGNANCY: No human data. Not recommended. LACTATION: Unknown if excreted in human milk. Should not be used during breast- † feeding. INTERACTIONS: Diuretics: may increase risk of dehydration and Long-term cardiovascular benefits hypotension. Insulin and insulin secretagogues: risk of hypoglycaemia; consider lower dose of insulin or insulin secretagogue. Effects of other 14% reduction in the risk of cardiovascular death, nonfatal myocardial medicines on Invokana: Enzyme inducers (e.g. St. John’s wort, rifampicin, 4 barbiturates, phenytoin, carbamazepine, ritonavir, efavirenz) may decrease infarction and nonfatal stroke (3-point MACE) HR 0.86 (95% CI 0.75-0.97). exposure of canagliflozin; monitor glycaemic control. Consider dose increase to 300 mg if administered with UGT enzyme inducer. Cholestyramine may 33% reduction in risk of hospitalisation for heart failure reduce canagliflozin exposure; take canagliflozin at least 1 hour before or 4-6 4 hours after a bile acid sequestrant. Effects of Invokana on other medicines: HR 0.67 (95% CI 0.52 - 0.87). Monitor patients on digoxin, other cardiac glycosides, dabigatran. Inhibition of Breast Cancer Resistance Protein cannot be excluded; possible increased † exposure of drugs transported by BCRP (e.g. rosuvastatin and some anti- Improved renal outcomes cancer agents). LEGAL CATEGORY: POM. PACK SIZES & MARKETING AUTHORISATION NUMBER(S): Invokana 100 mg film-coated tablets: relative risk reduction in time to first adjudicated nephropathy 30 tablets; EU/1/13/884/002. Invokana 300 mg film-coated tablets: 30 47% tablets; EU/1/13/884/006. MARKETING AUTHORISATION HOLDER: event (doubling of serum creatinine, need for renal replacement therapy, Janssen-Cilag International NV, Turnhoutseweg 30, B-2340 Beerse, Belgium. 5 ® INVOKANA is a registered trade mark of Janssen-Cilag International NV and renal death) HR 0.53 (95% CI 0.33 - 0.84). and is used under licence. © 2017 Napp Pharmaceuticals Limited. FURTHER INFORMATION IS AVAILABLE FROM: Mundipharma Pharmaceuticals 27% reduction in the progression of albuminuria in Limited, Millbank House, Arkle Road, Sandyford, Dublin 18. For medical 4 information enquiries, please contact [email protected]. UK/INV-18203. patients with normo- or micro-albuminuria HR 0.73 (95% CI 0.67-0.79). Date of Preparation September 2018. Adverse events should be reported to: HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: [email protected]. Adverse events should also be reported to Mundipharma Pharmaceuticals Limited on [email protected] or by phone on 01 2063800 (1800 991830 outside office hours) References: 1. Invokana SmPC www.medicines.ie 2. Davies MJ et al, Diabetes Care. 2018 Oct: 10.2337/dci18-0033 (http://diabetologia-journal.org/wp-content/ uploads/2018/10/Consensus-Report-ADA-EASD.pdf). 3. Wilding JP et al J Diabetes Complications 2015; 29;438-44. 4. Neal B. et al. N Engl J Med 2017; 377:644-657. 5. Perkovic V. et al Lancet Diabetes Endocrinol. 2018 Sep;6(9):691-704 INVOKANA® is a registered trade mark of Janssen- Cilag International N.V. and is used under licence. The recommended starting dose of Seize the moment to MUNDIPHARMA® and the ‘mundipharma’ logo are INVOKANA is 100mg once-daily. make years of registered trade marks of Mundipharma AG. Date of Item: November 2018. IRE/INVK – 18273 * an SGLT2i for treatment of T2DM patients with ASCVD, HF, CKD and for use in patients difference Distributed in Ireland by: Mundipharma Pharmaceuticals Limited, Millbank House, where there is a compelling need to minimise hypoglycemia and those with a compelling Arkle Road, Sandyford, Dublin 18, Ireland. Phone +353-1-2063800 need to minimise weight gain or promote weight loss www.mundipharma.ie † Compared to standard of care ” It is unlikely that global recession will be experienced, but global growth looks set to be somewhat slower than in 2018 and there are considerable risk factors that will need to be watched closely.”
economic momentum relaxed about interest in the economy has rates and a bit concerned been generally solid by the slowdown in but there are definite growth, particularly in signs of easing. There Germany. This bodes well are also justifiable for interest rates. concerns about President n The outcome for Trump and his trade Brexit remains deeply agenda. The growth of uncertain and will protectionism would continue to represent not be good for global a source of risk for growth, and Ireland Europe in general, but would be particularly for Ireland and the vulnerable given the UK in particular. A importance of external ‘soft Brexit’ would see trade to the economy. sterling strengthen and n Growth in the Euro Zone, a significant rebound the UK and China is in the UK economy, likely to soften further, which would be very n The pressure to of the high personal tax and emerging market good news for Ireland. increase expenditure burden; subdued wage economies are likely to However, Brexit remains on public services, growth for the past continue to struggle. a source of considerable particularly health, will decade, although wages uncertainty and defeat n Global geopolitics also remain strong and will will rise more strongly in for common sense. look risky, with Russia, pressurise the public 2019; rising house prices the rise of the right in The key domestic challenges finances. Public sector and rents will continue Italy, Hungary, Poland include: pay pressures will be to soak up household and Austria, the riots a particular challenge. disposable income; and n The imbalance in France, and the Ireland still has a Brexit will remain a between demand and relationship between the dangerously high level source of deep concern supply in the housing US and China being key of Government debt and uncertainty. market is putting issues of concern. that needs to be brought considerable upward Real GDP growth is forecast under control. n US interest rates were pressure on house to expand by around 5% in increased four times prices and rents and is n As the economy steadily 2019. Consumer spending is during 2018. The Federal undermining national moves towards full projected to grow by 3.2%; Reserve believes that competitiveness. It employment, wage the unemployment rate is rates will need to be appears likely that pressures are likely expected to fall below 5% but increased by 0.5% over house price inflation will to intensify and the should average around 5% for the coming year but moderate in 2019 due recruitment and the full year; and employment this may not be needed. to affordability issues retention of workers will is expected to grow by 1.5% Based on recent slower rather than adequate become a significant to average 2.29 million. A growth in the Euro Zone supply, but rents look challenge for all solid year looks in prospect, and the complete lack set to remain under employers. not least due to the strong of inflation, ECB rates considerable upward momentum carrying forward n The personal sector are likely to remain pressure. Housing supply from last year, but the risks will remain pressurised unchanged for the needs to increase as a and challenges will need to be due to a combination duration of 2019. The matter of priority. watched very closely. ECB is currently very
20 IPUREVIEW MARCH 2019 Challenging Times Ahead? Let Accord take care of you
Gregg Farrell John MacHale
David Lane Richard Doherty
Damien McCormack Martina Sweeney Padraic O’Brien
Further information is available on request from Accord Healthcare Ltd Euro House I Euro Business Park I Little Island I Cork I T45 K857 I Ireland 021-461 9040 Date of Preparation: Jan 2019 NA-371-01 PROFESSIONAL Jennifer Flaherty, ITT, Dan Ahern, Community Pharmacist Farranfore, Sinéad Flaherty, ITT and Tom Farrelly, ITT. A community pharmacy-based pilot project for BowelScreen in County Kerry
Bowel cancer is the second most common form of cancer in men, and third in women, diagnosed in Ireland. The most recent figure reported that 2,775 people were diagnosed with bowel cancer in 2017 (National Cancer Registry, 2018).
ndividuals feel that of the screening test. Some syndrome, altered bowel ITT with the support of the bowel cancer is not people often believe the habits and hemorrhoids. Irish Pharmacy Union, and in as widely discussed test is more complicated Mindful of looking for particular, Ms Pamela Logan, or advertised as than it is and/or that it is different ways of trying to Director of Pharmacy Services breast screening quite distasteful. In recent promote cancer screening, the with the IPU. The study was Iand therefore do not see years, there has been a shift National Screening Service’s commissioned and carried the importance of taking from dispensing medication Bowel Screen approached out between March and July part in screening especially towards patient care, placing researchers in the Institute 2018 across six community when they feel fine and do pharmacists in a prime of Technology Tralee (ITT) pharmacies in county Kerry. not have any symptoms position for delivering health to investigate innovative The sites represented a mix (Wackerbarth et al, 2005). messages and incorporating ways of attracting people of rural, medium and large There is also an element of cancer screening initiatives to participate in bowel towns in the county. In order social embarrassment around into their existing practice screening. This study sought to ensure a high level of bowel cancer, leading to it not (Havlicek and Mansell, 2016). to assess the effectiveness of consistency, pharmacists from being as freely discussed as Pharmacists are well placed a community pharmacy based the selected sites were invited other forms of cancer (Jones to have open discussions opportunistic bowel screening to a training workshop in the et al, 2010). The evidence with the public, as many intervention. This study was delivery of the BowelScreen would show that there is a people buy over-the-counter a joint project between the message and to educate concern amongst participants medication for common bowel National Screening Service them about how the bowel around the acceptability issues such as irritable bowel (Ms Lynn Swinburne) and the screening service operates.
22 IPUREVIEW MARCH 2019 “I quit smoking for her” Fergus O’Shea Help smokers quit with an unbeatable combination* from + Now PCRS REIMBURSEABLE Patch Mini FOR 24 HOUR CONTROL ON THE GO CRAVING RELIEF
*Provides significant improvements in quit rates vs patch alone. NiQuitin Clear 14mg Patches. Indication: Stop Smoking aid, Contains nicotine, Requires willpower. Always read the leaflet. Legal classification: GSL. PA 1186/18/5. MAH: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. Information about the product including adverse reaction, precaution, contra-indication and method of use can be found at: http://www.medicines.ie/medicine/12137/SPC/NiQuitin+CLEAR+14+mg+24+hours+transdermal+patch/ (14 mg). NiQuitin Mini Mint 1.5 mg Lozenges. Stop Smoking aid, Contains nicotine, Requires willpower. Always read the leaflet.Legal classification: GSL PA 1186/18/11 (1.5mg) PL. MAH: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. Information about the product including adverse reaction, precaution, contra-indication and method of use can be found at: http://www.medicines. ie/medicine/14493/SPC/NiQuitin+Mini+1.5mg+mint+lozenges (1.5mg). Date of preparation: 12/09/2018.
NiQuitin A4 Trade Ad (New KV Dad-Child) IRE v6 IPN.indd 1 24/10/2018 15:10 Patients aged between period in 2017 and 2018 were GP until they are very unwell. References 60 to 69 years, presenting compared with the return Through these interactions, 1. Connelly, D., 2007. Community for prescriptions or other rates in this initiative. Given the community pharmacist pharmacists can play a key role pharmacy items, were the wide disparity in sample therefore has the opportunity raising awareness of bowel targeted to receive an sizes, it is difficult to make to raise awareness for bowel cancer. Pharmaceutical Journal, intervention delivered by the a direct comparison and as screening (Connolly, 2007). 278(7452), pp.580-580. pharmacist recommending such should be treated with Pharmacists are in a prime 2. Havlicek, AJ. & Mansell, H. 2016. the BowelScreen home test. caution. Nonetheless, the position to aid with health The community pharmacist’s In total, 85 people signed kit return rates were very screening, as they are one role in cancer screening and up to take part in the home encouraging by comparison of the most accessible prevention. Canadian Pharmacy Journal, 149(5),pp. 274-282. test and of that number, 69 and certainly would suggest healthcare professionals were deemed to be eligible that community pharmacies to members of the general 3. Jones, R.M., Devers, K.J., Kuzel, to take part. Out of the are very well placed to assist public and are already A.J. and Woolf, S.H., 2010. Patient-reported barriers to 69 participants, 51 people with such health promotion actively involved with health colorectal cancer screening: returned the test kit, giving initiatives. promotion and prevention a mixed-methods analysis. an overall uptake rate of Most people feel that they as illustrated by their American journal of preventive 73.9%. For the purpose of can appropriately self-care participation in the influenza medicine, 38(5), pp.508-516. illustration, the national for these conditions at home vaccination programme. 4. National Cancer Registry, 2018. return rates for the same time and would not go to see the Cancer Factsheet Colorectal. [Online]. Available at: https:// www.ncri.ie/sites/ncri/files/ 09/04 – 06/05 2018 2017 Pilot Project Rates factsheets/Factsheet%20 No. Invited 28,879 22,985 69 colorectal.pdf [Accessed 26th December 2018]. Kits Returned 11,023 8,871 51 5. Wackerbarth, S.B., Peters, J.C. and Haist, S.A., 2005. % Return Rate 38% 38.5% 73.9% “Do We Really Need All That Equipment?” Factors Influencing Colorectal Cancer Screening Decisions. Qualitative Health Research, 15(4), pp.539-554. 6. World Health Organisation, 1994. The Role of the Pharmacist in the Healthcare System. [Online] Available at: http://apps.who.int/ medicinedocs/pdf/h2995e/ h2995e.pdf [Accessed 26th December 2018]. 7. Winawer, S., Faivre, J., Selby, J., Bertaro, L., Chen, T.H., Kroborg, O., Levin, B., Mandel, J., O’morain, C., Richards, M. and Rennert, G., 2005. Workgroup II: the screening process. UICC International Workshop on Facilitating Screening for Colorectal Cancer, Oslo, Norway (29 and 30 June 2002). Annals of oncology, 16(1), pp.31-33.
24 IPUREVIEW MARCH 2019 CONFERENCE
10 CPD SESSIONS TO CHOOSE FROM AND MUCH MORE
IPU NATIONAL PHARMACY CONFERENCE 10 – 12 May 2019, The Galmont Hotel, Galway pharmacyconference.ie
The face of community pharmacy is ever-changing with new initiatives always in the pipeline. The IPU National Pharmacy Conference ensures that you remain up-to-date with these developments through 10 informative educational sessions.
IPUREVIEW MARCH 2019 25 e have taken on valuable feedback from IPU members and worked with our Conference Subcommittee, IPU Academy, financial advisers, industry representatives and other organisations to develop a comprehensive and educational programme to support you with your CPD. We will provide you with a CPD template for each session which is designed to support your engagement with the CPD system developed by the IIOP. A certificate of attendance for your sessions will be sent to you after the conference. The conference programme features professionalW and business sessions, covering a wide range of topics. See below information on all our sessions or for a full description, please visit www.pharmacyconference.ie.
Clinical Sessions Business Sessions 5 Ways to Increase Your Wellbeing at Work Maximising the Return from your Dispensary Data (No Matter How Busy You Are) – a hmR Presentation 4.00pm, Friday 10 May 4.00pm, Friday 10 May This session will be delivered by Séamus Ruane, Galway- Health Market Research, for several years now, has been based contractor pharmacist with over 20 years’ experience in transforming your raw data into meaningful information to give community pharmacy. This workshop will give you actionable, your business the edge it needs in an extremely competitive evidence-based steps to help you improve your wellbeing at environment. Using the most advanced technological solutions, work. It provides a clear template to help you consistently we are helping you, the pharmacist to ‘maximise the return feel good and function effectively at work. Learn how to build from your dispensary data’. hmR’s Pharmacy Platform identifies positive emotion, increase engagement, and find meaning at opportunities within the data and helps pharmacists unlock work, all in an easy-to-apply format designed to make your hidden profit potential including generic opportunities. This changes last. Discover evidence-based, busy-proof wellbeing session will be delivered by Alan McCormick, Senior Manager – approaches that enable you to confidently handle common Pharmacy Business Intelligence, hmR Ireland. work challenges. Transform your Business using People, Process and Technology The Pharmacist in an Atrial Fibrillation Clinic . . . 8.30am, Saturday 11 May A Model of Care We are looking forward to welcoming Jay Patel, Pharmacist and Sponsored by Bristol Myers Squibb Executive Director, Day Lewis Plc, to speak on this topic at the 5.30pm, Friday 10 May conference. Pharmacy must adapt to the changing demands During this informative session, delivered by Edwina Morrissey, of both patients and commissioners. What innovation means Senior Clinical Pharmacist at Tallaght University Hospital, however, is often misunderstood. This session describes what you will gain a better understanding of atrial fibrillation, its innovation actually is and how business owners can innovate diagnosis, complications and treatment. After this session you leveraging three core assets (People, Process and Technology). will be able to review and counsel a patient on a direct oral anticoagulant and understand the pharmacist’s role in the atrial Economic Trends in 2019 and How they May Affect the fibrillation multidisciplinary clinic. Pharmacy Sector In Association with Moore Wealth Management The Role of the Community Pharmacy Team in 12.30pm, Saturday 11 May Supporting Palliative Care at Home This session will be delivered by Economist Jim Power where we 8.30am, Saturday 11 May will consider the Irish economic environment in general, the This exciting session is in association with Galway Hospice and behaviour of consumers, the public finances, Brexit, interest rates will demonstrate how community pharmacy can play a big part and how all of these issues impact on the pharmacy business. in supporting Palliative Care in the home. This session will be delivered by Karen McKee, Chief Pharmacist, Galway Hospice Leading Through Adversity Foundation. 4.15pm, Saturday 11 May Jack Kavanagh, Pharmacist and Motivational Speaker, will deliver Eczema Diagnosis and Treatment: Tips and Tricks for the on leading through adversity, which will reveal fundamental Community Pharmacist / Sponsored by A.Menarini truths we can all relate to about the ebbs and flows of life as 12.30pm, Saturday 11 May Jack relays his personal story of adversity and his journey from During this session, delivered by Dr Paul Ryan, Pharmacist and surviving to thriving in life. He will impart his biggest learnings GP, the most recent prescribing guidelines on eczema are put in his journey of personal leadership, resilience and growth into practice for the community pharmacist. Key learning points through the adversities we all encounter in our lives. Jack is set from this talk include pathophysiology of eczema, different to inspire us at what is set to be an invigorating conference. types of eczema seen in community pharmacy as well as the treatment of the common eczema types. Leading, Delegating, Communicating – How will you Manage? 10.00am, Sunday 12 May The Challenges Presented by Breast Cancer Survivors As a community pharmacist, you won’t just be a health Taking Antihormone Medication professional – you will also be both a manager and a leader of a 10.00am, Sunday 12 May team of people within a pharmacy. The role of a pharmacist is a This will be delivered by Elizabeth Summersby, RANP Oncology, position of responsibility and with it comes assumed obligation; Our Lady of Lourdes Hospital. Breast Cancer affects 1 in 9 Irish obligation to be in control, to be in authority, to solve problems, women and there are currently 2,883 new cases diagnosed as well as to temporarily manage resources, people, compliance, annually1. With early detection and an increasing number of targets and, above all, a health brand. There are three specific effective therapies, more women than ever are surviving breast skills needed to manage the potential challenges which you cancer. Therapies such as Tamoxifen and Aromatase Inhibitors may experience while working as a first-year pharmacist. These reduce the risk of recurrence by up to 50%2. These treatments may are; Communication Skills, Delegation Skills and Performance be used for up to 10 years3 and may result in long term side-effects. Management Skills. Join us in this session, delivered by Susan Madden, Principal, South East College – Further Education & 1. National Cancer Registry, 2016. Training, to discover how effective communication can help to 2. Cahir et al. 2015. 3. Goss, 2016. foster a good working relationship between you and your team, which can in turn improve morale and employee efficiency.
26 IPUREVIEW MARCH 2019 The conference also offers invaluable networking opportunities and face- APPEL Preceptor Training Pharmacists who would like to act as a Preceptor to a to-face contact with your colleagues. 4th-year pharmacy student under the new MPharm programme can undertake the required Preceptor There are numerous networking opportunities throughout training at this year’s IPU conference. These pharmacists the weekend, from the tea/coffee breaks in the Exhibition will then be positioned to oversee four-month APPEL Hall to the IPU President’s Dinner & Ball – a key social placements for 4th-year students in 2019. At the event in the pharmacy calendar. This year’s President’s conclusion of the session, participants will understand Dinner & Ball takes place on Saturday 11 May as part of the the new role of the Preceptor, how placements are conference weekend. You can book your dinner ticket on the structured and assessed, and the learning outcomes booking form provided for just €35. set for students. The session will identify strategies to successfully facilitate experiential learning placements through effective feedback, resolving conflict and calibrating expectations. This training Pharmacy Staff session will be delivered by Dr Maria Donovan, Practice Pharmacy staff and technicians can attend the Educator, University College Cork (UCC), and Eimear Ni conference for the full weekend for just €60! This Sheachnasaigh, Practice Educator, University Of Dublin, includes admission to all sessions and the Exhibition Trinity College (TCD). For more information on this Hall, as well as Friday night dinner and daily session, please contact the APPEL Team at [email protected]. refreshments and lunches (Saturday and Sunday). Pharmacy staff are a key asset to your pharmacy business and the conference is the ideal place for them to attend educational courses. To support the continuing education of pharmacy technicians, we will Conference Information also hold a CPD for Pharmacy Technicians session on the Sunday morning entitled Support and Care for and Registration Cancer Patients. The conference is open to all One in three people in Ireland are given a diagnosis Condition of entry pharmacists, non-pharmacist of cancer. This is almost always a life-changing event It is a condition of entry that pharmacy owners who are IPU which poses challenges for patients. Pharmacy staff you may be photographed Members, Pharmacy Interns can offer advice and support about medication and at the event and that your and all pharmacy staff who lifestyle measures to help improve patient outcomes. image may be used on IPU work for members of the IPU. At the end of this course, pharmacy technicians will and IPU National Pharmacy You can register online at be able to discuss the appropriate use of anti-emetics Conference material. The IPU www.pharmacyconference.ie and other ancillary treatments prescribed for patients reserves the right to refuse or by completing the form receiving chemotherapy or radiotherapy; advise entry to anyone it sees fit. overleaf and faxing or posting patients on how to maintain good general health it back to the details on and what to do if they feel unwell; and offer practical the form. advice on skin care and general appearance to help Accommodation Your registration fee includes patients to look good and feel better. The Galmont Hotel (formerly n Admission to all the Radisson) is located in sessions Galway city, just a three- minute walk from the central n Entry to Exhibition Hall Eyre Square and overlooking n Friday night dinner, Galway Bay. It is also just a with pre-dinner drinks short walk from the main railway and bus stations. Use n Daily refreshments and code IPU2019 when making lunches (Saturday and your reservation for a special Sunday) conference rate. The hotel can n Conference bag be booked by contacting them on 091 538 300.
Cancellations Please complete the form on and refunds the reverse and return it to NEWLY the IPU to book your place Cancellations made prior for the 2019 IPU National to 19 April will be refunded QUALIFIED Pharmacy Conference. in total. Refunds will not be You can also visit www. processed after this date. PHARMACISTS! pharmacyconference.ie/ Accommodation cancellations Registration to book a place. If you first registered with are at the discretion of the The Early Bird rate for IPU Galmont Hotel, Galway. the PSI after 1 September Members is available until 29 2016, you can attend the March 2019. conference for just We hope to see you there! €80.
IPUREVIEW MARCH 2019 27 Brought to you by
14th - 15th April, Aviva Stadium, Dublin
United, we do better
SAVE THE For further information please contact DATE! Laura Payne Brand and Trade Marketing Manager 14th-15th United Drug Wholesale Mobile: 087 383 2297 April Email: [email protected]
16029 UD Pharmacy Show 2019_210mmx297mm Date In Diary AD.indd 1 15/02/2019 14:10 IPU NATIONAL PHARMACY CONFERENCE 10 – 12 May 2019, The Galmont Hotel, Galway
REGISTRATION FORM Please complete this form in BLOCK LETTERS. Please mark below which events you would like to
NAME: attend. Please ensure you only select one option where there are parallel sessions. PHARMACY: FRIDAY 10 MAY 12.30pm – o APPEL Preceptor Training – Supporting ADDRESS: 3.30pm 4th-year Student Pharmacists on their Journey to Practice 4.00pm – o Maximising the Return from your 5.00pm Dispensary Data – a hmR Presentation PHONE NUMBER: OR o 5 Ways to Increase Your Wellbeing at EMAIL: Work (No Matter How Busy You Are) 5.30pm – o The Pharmacist in an Atrial Fibrillation 6.30pm Clinic . . . A Model of Care CONFERENCE FEE 8.00pm o Dinner Early Bird Fee* €100 Non-Members €185 SATURDAY 11 MAY Attendance Fee €130 Pharmacy Interns €40 8.30am – o Transform your Business using People, Pharmacy Staff €60 9.30am Process and Technology OR Newly Qualified Pharmacists o The Role of the Community Pharmacy registered after September 2016 €80 Team in Supporting Palliative Care at Home *The Early Bird Rate is for members only and is valid if booked o and paid for before 29 March 2019. 10.00am – Plenary Session 12.00pm 12.30pm – o Economic Trends in 2019 and How they PRESIDENT’S DINNER & BALL 1.30pm May Affect the Pharmacy Sector Dinner €35 Dinner Guest €35 OR o Eczema Diagnosis and Treatment: Tips Name of Dinner Guest: and Tricks for the Community Pharmacist 1.30pm – o Lunch Payment can be made by cheque or by supplying your credit card 2.15pm details below. Please make cheques payable to Irish Pharmacy Union 3.00pm – o Panel Discussion: Sláintecare – and return with this form. 4.15pm the Future Shape of Healthcare 4.15pm – o Leading Through Adversity CREDIT CARD DETAILS 5.15pm Name of Cardholder: SUNDAY 12 MAY Card o Number: 10.00am – Leading, Delegating, Communicating – 11.00am How will you Manage? Expiry CVV OR Date: Number: o The Challenges Presented by Breast Cancer Survivors Taking Antihormone Medication Please return all forms to: Irish Pharmacy Union, 11.15am – o IPU AGM – Reports & Motions Butterfield House, Butterfield Avenue, Rathfarnham, 1.15pm OR Dublin 14, D14 E126. If paying by credit card, you 11.15am – o Support and Care for Cancer Patients can also fax the form back to 01 493 6626. You will 12.45pm (CPD for Pharmacy Technicians) receive an email to confirm your registration and 1.15pm o Lunch sessions booked. Alternatively, you can register online at www.pharmacyconference.ie. PROFESSIONAL Sarah O’Connor, CEO, Asthma Society of Ireland How pharmacists can help to encourage good asthma management
The Irish Pharmacy Union and the Asthma Society of Ireland have teamed up to encourage more people to take control of their asthma and practice proper inhaler technique. Sarah O’Connor, CEO of the Asthma Society of Ireland, details how pharmacists can help to encourage good asthma management and also outlines how pharmacists can team up with the Society to improve their own asthma knowledge.
reland has the fourth The Asthma Society is the highest rate of asthma national charity dedicated to in the world – 470,000 empowering Ireland’s people people in Ireland have with asthma to take control asthma – one in five of their asthma by providing Ichildren and one in ten adults. them and their families This makes asthma the most with information, education, common chronic condition in services and support. the country. A person visits The Asthma Society has A&E in Ireland because of a wealth of resources that asthma every 26 minutes and allow people with asthma to the condition is responsible take control of their condition for 5,000 hospital admissions and live a healthier life. The every year. Sadly, more than Society also has a number one person a week dies as of resources that will be a result of their asthma. of benefit to pharmacists, Shockingly, 90% of asthma including our inhaler deaths are preventable and technique videos, our Asthma asthma deaths are on the rise. E-Learning Programme, our Asthma in the Pharmacy Day clinics and our joint Asthma and COPD Adviceline.
30 IPUREVIEW MARCH 2019 Inhaler Technique recent focus group, conducted include the newest inhalers issues in asthma care and by the Asthma Society on the market. Pharmacists provides excellent training Proper inhaler technique is of Ireland, showed that should recommend these in up-to-date best practise vital for people with asthma pharmacists are considered to videos to people with asthma asthma management. to properly manage their have the highest satisfaction when purchasing medication Pharmacists who undertake condition. It is estimated that ratings of any kind of but can also use these the programme will be able to 60% of people with asthma healthcare professionals in videos to brush up on their enhance their skills and gain a in Ireland are not managing terms of the asthma supports own knowledge of inhaler comprehensive understanding their asthma as they should, provided. technique. of international best practices putting about 280,000 people Pharmacists can and do act of asthma care including in danger of having an asthma as key educators for improving diagnosis, assessment, attack, which in some cases inhaler use. Patients using Asthma E-Learning treatment and monitoring can be fatal. inhalation therapies need Programme of adults and children with Poor inhaler technique is a careful instruction, including asthma. major problem in managing step-by-step demonstration Another resource the This updated resource asthma because the patient and observation of their Asthma Society offers that covers all aspects of asthma does not receive an optimal technique when dispensing is extremely beneficial to care and is designed to provide dose of the prescribed drug, the medication. Pharmacists pharmacists is the Care of the confidence and skills resulting in reduced response are available, not just when Adults and Children with Asthma necessary to provide best- to treatment and poor asthma patients obtain their first E-Learning Education Programme, practice care for people with control. As every pharmacist inhaler, but also when which has been developed asthma. The five modules knows, even if the best they obtain refill inhalers, with clinical expertise within the resource are: medication is prescribed, if giving pharmacists the ideal from the National Clinical n Diagnosis and it is not used correctly it will opportunity to assess and Programme for Asthma, Assessment of Asthma; not have any therapeutic educate their patients on an patient and service user effect. This is why proper ongoing basis. expertise from the Asthma n Treatment of inhaler technique is extremely Pharmacists should also be Society of Ireland, healthcare Paediatric Asthma; important. aware of the inhaler technique delivery expertise from n Guided Self- Pharmacists are in an videos which are available on frontline staff and input from Management/Asthma excellent position to identify www.asthma.ie. These videos other stakeholders including Action Plans; and patients whose asthma may are suitable for both patients ANAIL, Irish Thoracic Society not be well controlled, due to and healthcare professionals and RCPI. The e-learning n Treatment of poor inhalation technique. A and were recently updated to programme addresses key Asthma Attack.
Figure 1: Inhaler Technique Figure 2: Asthma E-Learning Programme
IPUREVIEW MARCH 2019 31 The programme takes The nurse will complete and all their relevant social asthma and/or COPD. They approximately three hours an asthma control test to media channels. If you would can help with what to do in to complete. This resource is gain an understanding of the like to book an Asthma in the the event of an asthma/COPD geared towards self-directed patient’s asthma symptom Pharmacy Day clinic for your attack and the signs and learning, allowing learners control and discuss potential pharmacy, please contact the symptoms of asthma/COPD, to go through the modules at ways of improving this score if Asthma Society and we will answer questions after a GP or their own convenience with necessary, advise patients on arrange a date that suits your consultant appointment, deal structured training and review medication usage and answer pharmacy. The Asthma Society with triggers that may cause exercises to reinforce the any questions they may have. would like to thank GSK for a serious escalation and help learning. The Asthma Society Where patients are their kind support of this to put an Asthma Action Plan/ is encouraging all pharmacists identified as having poor programme. COPD Self Management Plan to utilise this free cutting-edge asthma control, they will in place. After speaking to one be advised to attend the training. of these nurses, the user will appropriate healthcare The joint Asthma be fully equipped with the professional, and the nurse and COPD Adviceline information and skills they will guide the patients on Asthma in the need to improve their health a range of topics including The joint Asthma and COPD Pharmacy Day clinics and to stay as well as possible. asthma in children, allergies, Adviceline is a free service In 2018, the joint Asthma The Asthma Society runs asthma management, which users can call on 1800 a number of Asthma in inhaler technique, peak flow 44 54 64. The service involves and COPD Adviceline service the Pharmacy Day clinics monitoring and smoking a call back from an asthma was commended for Patient throughout the country. cessation. respiratory nurse, who will Education Project of the Year The Asthma Society’s nurse There is a nominal fee of undertake multiple calls with in the Irish Healthcare Awards specialists are available €90 paid by the pharmacy. a person with asthma/COPD or and the feedback from service at these events to provide However, all other costs their carer, to ensure that they users has been very positive. advice, support, information are covered including the are better informed and able and patient education on asthma nurse specialist to manage their asthma/COPD. asthma. The nurse will and the provision of a box The Asthma Society’s For more information about typically see up to 11 patients of literature. The Asthma respiratory nurse specialists any of the above, please email over a period of six hours, Society will advertise the work through every aspect [email protected] or contact usually 10.00am – 4.00pm. event on www.asthma.ie of life with callers who have the office on 01 817 8886.
32 IPUREVIEW MARCH 2019 The complete range of pain relief
Paralief Range Pain Relief - Full prescribing information is available on request. For retail sale through pharmacies only.
THE STATED DOSE SHOULD NOT BE EXCEEDED. Please refer to the individual product Summary of Product Characteristics.
PA Holder: Clonmel Healthcare Ltd., Clonmel, County Tipperary: Paralief 500 mg Tablets - Contains paracetamol PA 126/20/1 (24 pack size) Paralief Cold+Flu Hard Capsules - Contains paracetamol, phenylephrine HCl and caff eine PA 126/272/1 Paralief Hot Lemon 600 mg Powder for Oral Solution in Sachet - Contains paracetamol PA 126/20/6 Paralief 500 mg Eff ervescent Tablets - Contains paracetamol PA 126/20/4
PA Holder: Chanelle Medical, Loughrea, County Galway: Paralief Night Film-coated Tablets - Contains paracetamol and diphenhydramine HCl PA 688/38/1 Paralief Extra Film-coated Tablets - Contains paracetamol and caff eine PA 688/50/1
For more information go to www.clonmel-health.ie. Date prepared: January 2019 2018/ADV/PAR/131H PROFESSIONAL Tara McMahon, Margaret Bermingham and Brendan T. Griffin, School of Pharmacy, University College Cork
An analysis of the pharmacist workforce capacity in Ireland Key findings
This study examines pharmacist and pharmacy numbers in Ireland over the n The number of pharmacists in Ireland has increased by 90% over the last 15 years. last 15 years, in conjunction n There has been a 47% increase in the number of with economic and pharmacies in Ireland during the same time. n Despite the opening of RCSI and UCC Schools of demographic data to allow Pharmacy in 2002 and 2003 respectively, 57% of new PSI registrants over the last 15 years qualified improved understanding via the EU route, predominately from the UK. and trending of pharmacy n Ireland’s output of pharmacy graduates per population is 40% lower than the UK and the workforce descriptors in number of pharmacy graduates per school of Ireland. By examining the pharmacy in the UK is over twice that of Ireland. n Any risk to the free movement and mutual evolution of the workforce, recognition of pharmacists between the UK and EU as a result of Brexit would lead to significant conclusions can be drawn shortages of pharmacists in Ireland. regarding factors that have n Of 10 comparator EU countries, Ireland has the joint highest number of pharmacists and the impacted the supply of second highest number of pharmacies per head pharmacists and forecasts can of population. n Pharmacy workforce estimates in Ireland are be made regarding factors based on total registrants on PSI, which may overestimate capacity given that 21.5% of that may impact pharmacist pharmacists do not state their area of practice. numbers into the future.
34 IPUREVIEW MARCH 2019 Pharmacy workforce Figure 1: Graph showing total number of pharmacists added to the over the past 15 years PSI register annually via national and EU routes and total number of pharmacists in Ireland (cumulative) between 2003 and 2017 The total number of pharmacists in Ireland National Route EU Route Total number of pharmacists (cumulative) increased from 3,208 in 2002, to 6,097 in 2017 – an increase 6000 s of 90%. On an annual basis, 5500 the average number of new additions to the PSI register 5000 is 341, qualifying by either the national, EU or third 4500 country routes. The number of pharmacists added via the 4000 national route has increased 3500 from an average of 71 Cumulative no. of pharmacist annually from 2003 – 2006, 3000 to an average of 153 from 300 2007 – 2017. This is primarily a reflection of the increase in pharmacy graduates 200 nationally coming from RCSI and UCC Schools of Pharmacy. Under Directive 2005/36/EC, 100 there is mutual recognition of professional qualifications which enables the free 0
movement of pharmacists Annual additions to register 2003 2004 2005 2006 200720082009201020112012 20132014201520162017 between EU member states. Year The number of pharmacists that registered with the PSI Data taken from PSI Annual Reports 2004 – 2016 and PSI Statistics. via the EU/EEA route has seen substantial fluctuation in recent years. Numbers increased dramatically from 2004, peaking in 2007 (306 registrants), most likely coinciding with the high demand for pharmacists, driven in no small part by the Celtic Tiger economy of the time. The numbers of EU registrants sharply declined from 2007 – 2009 as Ireland was hit by recession, healthcare budget cuts and net-migration out of Ireland. The number of EU pharmacists registering with the PSI fell by 66% between 2007 and 2009. Registrant numbers via the EU route have recovered since 2009 and stabilised at between 43% to 58% each year since. Registrations via the third country route are relatively few, with an average of only four pharmacists per year registering via this route since 2010. The third country route of registration, through which pharmacists outside the EU/ EEA register with the PSI, commenced in 2010. Prior to 2006, reciprocal registration agreements operated on the basis that pharmacist qualifications were mutually
IPUREVIEW MARCH 2019 35 recognised between Ireland- Figure 2: Number of pharmacists and pharmacies per 100,000 of population New Zealand and Ireland- (2015) in comparison countries. Patient facing pharmacists in Ireland Australia. Between 2003 (i.e. community and hospital-based) also shown and 2006, an average of 49 pharmacists per year registered via this reciprocal registration approach. However, this route was terminated in June 2006. The total number of pharmacies in Ireland has consistently increased over the last 15 years. In 2003, there were 1,317 pharmacies; by the end of 2017 this number increased to 1,932 – an increase of 46%. As a result of this, the number of pharmacies per 100,000 of population has increased from 33 to 40.2. This has resulted in increased patient access to pharmacists in a community setting, facilitating greater provision of primary healthcare services, and has also increased competition in the sector.
Brexit: A potential risk to the Irish pharmacy workforce Source: Organisation for Economic Co-operation and Development (OECD) Health Expenditure, Despite the increase in Financing, Healthcare resources reports and Eurostat Health Personnel Statistics Reports pharmacists qualifying nationally in recent years, it is clear that the pharmacist and mutual recognition of Brexit to pharmacy capacity of population (121), while workforce in Ireland is heavily pharmacy qualifications is real given how reliant the Netherlands has the reliant on pharmacists that will be upheld/withdrawn the pharmacist workforce lowest (21). However, it qualify outside of Ireland. when the UK leaves the EU. in Ireland is on UK-trained should be noted that the Since 2003, 62% of new However, any restrictions to pharmacists. data for Ireland represents registrants to the PSI qualified this free movement will have all pharmacists licenced to outside of Ireland, with 57% a substantial impact on the practise – i.e. all pharmacists registering via the EU route pharmacist workforce. For Pharmacy capacity in on the PSI register. As a and 5% via the third country this reason, Brexit poses a Ireland compared to result, pharmacists that are route. The vast majority of EU- significant risk to the future other EU countries not practising in patient- qualified new registrants are capacity of the pharmacist facing roles, such as industry, trained in the UK/Northern workforce in Ireland. With the aim of benchmarking academia, regulation etc., Ireland (in 2017, 113 out of The uncertainty around the pharmacist workforce in are included, which may 170 EU-qualified registrants Brexit is also likely to impact Ireland to other countries, overestimate pharmacy were trained in UK/Northern on the numbers of Irish a number of comparison workforce capacity. As of Ireland) and it would seem students applying to study in countries were chosen based 1 October 2018, 70.5% of reasonable to assume the the UK through UCAS. Since on a range of demographic registered pharmacists majority are Irish students June 2016, the overall number and economic descriptors identified as working in who studied pharmacy at a of applicants has fallen by (population, GDP/capita, patient-facing roles (i.e. UK university. 28%. While this study did not % GDP and % Government community or hospital Leaving aside the examine precise figures on spending spent on healthcare, pharmacy), 5.5% identified socioeconomic debate the number of Irish students HDI values). This ensured that as working in non patient- surrounding the national registering at schools of the chosen countries broadly facing roles (i.e. academic, policy on limiting pharmacy pharmacy in the UK, it is share common goals in terms industry, regulatory) and 2.5% places in Irish universities to reasonable to assume that of economic, environmental, identified as non-practicing less than 50% of the current there will be a significant social and healthcare or ‘other’. However, 21.5% of labour market needs, it is reduction in the number of standards, therefore pharmacists did not state clear that pharmacy services Irish students qualifying as justifying that comparisons their area of practice. This remain highly reliant on Irish pharmacists in the UK from between these countries are is a substantial proportion students training at schools 2020/21 onwards. While the appropriate. and leaves much room for of pharmacy in the UK. It is implications of Brexit are as Ireland and Belgium have error when estimating the unclear, as of yet, the extent of yet uncertain, the risk of the joint highest number total percentage of patient- to which the free movement of pharmacists per 100,000
36 IPUREVIEW MARCH 2019 79th FIP World Congress of Pharmacy and Pharmaceutical Sciences Abu Dhabi, United Arab Emirates 22-26 September 2019
New horizons: Navigating winds of change New technologies, new roles, new opportunities for pharmacy
Do you want to be inspired to take on new roles and be prepared for success in a world of change? Wherever you practise, FIP can help you stay ahead of the game so that you can provide the best care for patients.
As we develop new skills to manage new technologies such as WELCOME TO ABU DHABI robotics and the digitalisation of health care, it is important that Abu Dhabi is a modern, cosmopolitan city with an ancient heritage we do not compromise quality and safety. where respect for the past informs the present and shapes the future. There are historic buildings, engaging tours and a packed Come to the Abu Dhabi congress, which will help you develop calendar of events covering the arts, culture, sports and trade. the knowledge and attitudes to adapt to emerging new roles Visitors will encounter a diverse emirate, with deserts, beaches, through networking with pharmacists and scientists from all oases and mountains, and there are ultra-modern malls and small areas of practice and from all around the world. souk-like stores to cater for their every (tax-free) shopping need.
CONGRESS STREAMS A > New trends in science, practice B > New roles, opportunities and C > Health now! Responding to the D > Targeting special interests and education responsibilities challenges of today Looks at special interests in the Focuses on new technologies, Examines pharmacists’ roles and Recognises that challenges can be different fi elds of pharmacy and digitalisation of health care, the roles of individuals, looks faced by looking at new research, pharmaceutical sciences. robotics, individualisation of at new services and the skills ethical considerations, new values, therapy, the provision of edu- required to advance them, and access to health, health systems, cation via virtual classrooms, highlights the importance of sustainability, environmental integrating science and practice education and of collaboration sustainability, non-communicable in teaching, communication, not only with pharmacy collea- diseases, empowerment of patients, people-centred care, and ethical gues but also with other health- empowerment of women, quality challenges. care professionals. and assessment.
Note Some congress sessions are Please fi nd more information: accredited for continuing abudhabi2019.congress.pharmacy education. Check our website. Figure 3: Number of pharmacies per 100,000 of population in 2007 pharmacists’ roles are varied and 2015 in comparison countries and may contribute indirectly to improving accessibility 60 to medicines, clearly segmentation of the data to 50 allow comparisons of patient- facing pharmacist density between countries will allow 40 more reliable benchmarking in the context of access of 30 patients to pharmacy-related services. 20 Belgium has the highest number of pharmacies per 100,000 of population, 10 followed by Ireland. However, Number of pharmacies/100,000 it is important to note that 0 pharmacy numbers have
d d s y n K decreased in Belgium between e U rwa 2007 and 2015, while numbers Austria Finlan Irelan Swed Belgium Denmark Germany therland No are continuing to increase in Ne Ireland. This illustrates that Pharmacies/100,000 (2007) Pharmacies/100,000 (2015) even though Belgium has the highest number of pharmacies Source: Organisation for Economic Co-operation and Development (OECD) Health Expenditure, currently, if current trends Financing, Healthcare resources reports and Eurostat Health Personnel Statistics Reports continue, Ireland will overtake it. Even though other countries (Norway, Sweden, UK) have facing and non patient-facing of pharmacy practice. Based comparison countries. It was shown increases in pharmacy pharmacists in Ireland on the total number of unclear if the figures given numbers in recent years, their and pharmacy capacity registrants on the PSI register, for the comparison countries numbers are still far below predictions. Ireland is significantly above reflect all pharmacists Ireland. The total number of Therefore, using the total the median in terms of the registered with the national pharmacies per 100,000 of number of pharmacists when number of pharmacists per professional body or registered population in Ireland is still comparing to other countries population. Using the adjusted to practise in patient-facing twice that of the UK. leads to a misleading figure of 70% reporting as roles, and is therefore a Ireland lies exactly on assessment of the capacity patient-facing brings the limitation of the current study. the median set by the of the patient-facing sectors overall figure in line with the While non patient-facing comparison countries in terms of pharmacy graduates per population. However, the number of graduates per Figure 4: Number of pharmacy graduates per 100,000 population and average number school of pharmacy in Ireland of graduates per school of pharmacy (2014) in comparison countries is below the median at an average of 50 graduates per school. In the UK, the average number of graduates per school of pharmacy annually is around 114 – more than double the Irish figure. These two indicators of pharmacy education in Ireland show that despite the addition of RCSI and UCC Schools of Pharmacy, Ireland’s output of national pharmacy graduates is still low relative to other comparison countries.
The full report, including methods, bibliography and additional data, is published on the UCC Open Research Repository which can be accessed via https://cora.ucc.ie/ handle/10468/7424.
Sources: Number of pharmacy graduates (2014) - OECD. Number of Schools of Pharmacy - PHARMINE 2011 Number of pharmacy graduates/100,000 population (2014) - Calculated. Avg. number of graduates/School of Pharmacy -Calculated
38 IPUREVIEW MARCH 2019 BUSINESS Larry Ryan, Director, Behaviour & Attitudes
Reframing community pharmacy
Early in 2018, the Irish Pharmacy Union (IPU) commissioned a project to understand why an increasing number of pharmacy students are opting for careers outside of community pharmacy. Working with Behaviour & Attitudes (B&A), a number of separate committees inputted at the project briefing phase, leading to a multi- stage project with qualitative and quantitative elements, which took a 360 degree look at pharmacy in Ireland today.
n extensive series of focus groups with students and pharmacists Aat all levels (from recent graduates, right through to owners) was supplemented with interviews among key opinion leaders and educators. Having completed the qualitative phase in the Spring of 2018, a quantitative phase was rolled-out through the summer. This interviewed both IPU members and indeed co-operated with other representative groups and interests, so that the net could be cast more broadly to integrate the views of some who have already turned away from the sector.
IPUREVIEW MARCH 2019 39 The study illustrated a potential that their degree support and structures so that can seem, whether dealing wide range of ways in which offers them, with many pharmacists feel less isolated with admin, working long pharmacy is changing and finding their heads turned and alone. hours or juggling the many how the perspectives of by opportunities in pharma, Graduates seem mainly HR and staffing challenges many graduates, thinking tech, and consulting. Indeed, attracted to community that be-devil owners in about a future in pharmacy, it shouldn’t be surprising pharmacy by the vocational today’s much longer opening may be different to previous that few millennial graduates elements, working with pharmacies. Rather than being generations. Rather than aspire, in their early twenties, patients, spending time attracted by the challenge attempt to detail all of the to what some perceive as a with them and reviewing and variety, many graduates findings here, we thought lifelong career. Many seem their needs. However, see something quite far it preferable to look at a far more interested in roles they see within pharmacy from what they had hoped number of specific themes that evolve and change, with nowadays a growing array of for and envisaged. This which owners probably need the scope for progression and administration and regulation, echoed what we had heard to reflect and act upon. The advancement, overseas travel which undermines the appeal from the student groups; wider report is downloadable and the rewards of teamwork of the sector. In particular, they may learn more about from the IPU website and and mutually supportive many working as supervising running a pharmacy, but it is elements of it are feeding working environments. and superintending something they don’t seem at into the work of a variety of Working as often the most pharmacists seem weighed all confident about and look different committees’ work senior person in a pharmacy, down by an escalating raft on it with trepidation. While streams, being shared with with little scope for peer group of bureaucracy that sharply pharmacy education may others in the sector, and interaction and support, can detracts from job satisfaction. have moved on considerably, it informing the lobbying activity seem quite unattractive by This can be quite apparent hasn’t instilled the necessary of the IPU. comparison. It is important to students and trainee confidence and business Pharmacy graduates today that employers recognise pharmacists and causes many acumen to make students have a much broader vista; these shifts and try to build to re-evaluate their career want to embrace an in- they see many different steps and stages into a role choices. pharmacy role. areas in which they could that can seem seamless and Students spend a lot of A lack of evolution of potentially immerse un-evolving to graduates. time in pharmacies these the role of the community themselves. They have a Equally important, is the need days and they often remark pharmacist in Ireland is wider sense of the scope and to develop better peer-to-peer at how stressed pharmacists generally contrasted with a
Figure 1: College ambitions Education/ Regulatory Industry 11% 1%
Hospital 12%
Community 63%
40 IPUREVIEW MARCH 2019 Community pharmacy perspectives
Young people now are more interested in an evolving career than in a fixed profession.
Job satisfaction is low:
5.4 out of 10 is the average sector score
Interaction / patient care. 55% Rewarding/helping/part of team. 45%
- Over regulated. 47% - Paperwork/red tape. 25%
- Admin/bureaucracy. 21% ? - More staff/long hours/no breaks. 21% - Public respect/recognition. 21%
Other career options offer students more:
Progression and change Working in groups Recognition Salary tiers Collegial atmosphere Travel Specialisation Mutual support Benefits
Periods of career stress:
Superintendent Supervising Responsibility Challenge Student Trainee Locum Regulation Feeling under siege
Just 1 in 3 would recommend 1 in 3 are optimistic Failing to evolve/change/adapt community pharmacy nowadays. about its future. a significant issue with UK in sharp contrast.
Students and locums not Few aspire to own a The sector needs to regain attracted by seniority. pharmacy. confidence and find its voice.
IPUREVIEW MARCH 2019 41 much more developed role be contributing to graduates Likes about community pharmacy % in Britain and elsewhere. deciding to look elsewhere. as a career (spontaneous) Pharmacists in Britain are Some key areas that need to leading clinics, effectively be addressed include: Interaction with customers / community 55 prescribing and managing the n Building more steps and integration / community care care of patients, and equally stages into a pharmacy are felt to have a much Helping people / rewarding / part of a 46 career, so that it loses a better and more consultative dedicated team – making a difference sense of seamlessness, working relationship with GPs. of a lack of challenge, This is sharply contrasted Health expertise / healthcare provision – 10 change and the potential providing good quality healthcare by a lack of change and for progression; development here and Variety 9 undoubtedly contributes to n Creating better peer-to- a sense among graduates peer support networks so Learning opportunities 6 that community pharmacy in that young pharmacists Ireland may offer them less don’t feel isolated; Flexibility 6 in the future. Unquestionably, n Working to reduce the Dislike profession / nothing appeals 6 those leading the sector need amount of bureaucracy to agitate for change and Interesting 5 and admin and to shift evolution, not just to keep up the burden of what with global shifts, but also to Self-employed / entrepreneurship / ability to 5 remains onto support run own business ensure that students perceive staff; the role as more dynamic and Health / medicines / wellbeing of patient 5 capable of evolution. n Developing more The quantitative phase opportunities for Good money 4 illustrated something that patient interaction and we had started to suspect ultimately convincing during the initial groups the authorities that and in-depth interview; that pharmacists need to own many pharmacists are bad more of this territory; at delegating and often don’t n trust others to perform tasks Insinuating more “ Unquestionably, that they can do themselves. business training For many, this leads them to into the pharmacy those leading the micro-manage and become curriculum, so that excessively embroiled in many young pharmacists are administrative tasks that more enthusiastic about sector need to others could equally complete. this important aspect; Unquestionably, pharmacists and agitate for change need to learn how to delegate, n Ensuring that but equally the sector needs placements in to develop a cadre of workers pharmacies are and evolution, not who can complete the routine rewarding and admin that relates to schemes, stimulating and not just to keep up dealing with the PCRS and the leaving students with other tasks that pharmacists a fear of ancillary need to shed to find the time elements for which they with global shifts, to deal with patients. feel unprepared. The study highlighted but also to ensure some ancillary issues that gave cause for concern. In The project was undertaken for particular, morale and job the IPU by Behaviour & Attitudes that students satisfaction are poorer in the with the generous help and sector than they might be, participation of many across the perceive the role with those in more senior and sector. B&A and the IPU would responsible roles seeming like to pass on their thanks and particularly bowed down. to remind all that copies of the as more dynamic The project has illustrated published research report are many issues which won’t available to download from the and capable of come as a particular website www.ipu.ie. surprise to those working Larry Ryan is a Director of evolution.” in the sector. What may be Behaviour & Attitudes and salutary, however, is the he takes charge of all studies extent to which these may undertaken for the IPU.
42 IPUREVIEW MARCH 2019 PROFESSIONAL Peter Murphy, CEO, Epilepsy Ireland
Epilepsy Ireland: committed to meeting the needs of everyone with epilepsy
pilepsy is more level of awareness during a 26 March is Purple Day common than you seizure, and other features. might think. Over This means that terms such and Epilepsy Ireland CEO, 37,000 people in as simple partial seizure Peter Murphy, discusses Ireland over the and complex partial seizure ageE of five have epilepsy, are now replaced with Focal the condition and the making it one of the most Aware and Focal seizure common neurological with impaired awareness work of the organisation conditions but, despite its respectively. prevalence, it remains a much Epilepsy affects people of across the country misunderstood and often all ages, but is more prevalent stigmatised hidden disability. in children, adolescents and The word ‘epilepsy’ is those over 65 years. It is also used to describe a group of more common in people with disorders, all of which are an intellectual disability. characterised by recurrent In about 60% of cases, unprovoked seizures no specific cause can be involving abnormal electrical identified. In the remaining activity in the brain. About 40% of people, common one in every 20 people will causes include head injuries, have a seizure at some time strokes, brain infections, during their lives. birth defects and genetic For decades, the terms conditions. partial and generalised With anti-epileptic drug seizures were used to (AED) treatment, up to 70% describe types of seizures. of people with epilepsy can Partial seizures were those achieve seizure control, starting in one area or side of while surgery or vagus nerve the brain, while generalised stimulation, as well as the seizures were those occurring ketogenic diet in children in both sides of the brain are also options that may at the same time. In 2017, be considered. Deep brain The International League stimulation, cannabinoids and Against Epilepsy revised its personalised therapy targeted classification of seizures. The to specific genetic mutations, new classification is based are just three areas of current on three key features: where research that offer hope for seizures begin in the brain, the future.
IPUREVIEW MARCH 2019 43 However, there are at least anxiety, wellness and personal 10,000 people in Ireland confidence through meditation living with uncontrolled and personal development. seizures, and for this group in We also provide facilitated particular, the consequences support sessions for those of epilepsy can be long- recently diagnosed with lasting and significant. It can epilepsy, called the Living Well affect the person’s education, with Epilepsy Toolkit. The employment, psychological Toolkit is a comprehensive and social functioning, self- introduction to epilepsy esteem and independent management and includes living. People with epilepsy handy resources such as a must also cope with the seizure diary, safety checklist physical impact of seizures, and an epilepsy knowledge the side-effects of medications checklist. Demand for our and for many, the social services has grown by almost stigma and economic impact 40% over the past three years that can be associated with it. due to these new programmes Purple Day 26 March There is also an increased risk and to strong links with Purple Day is an international grassroots effort of mortality associated with clinical epilepsy services dedicated to increasing awareness about epilepsy epilepsy with an estimated nationwide. worldwide. Iconic buildings around Ireland will be 130 epilepsy-related deaths in Another important service lighting up purple to mark the occasion and we are Ireland each year. which continues to grow is inviting people to wear purple and host events in our training programme in support of epilepsy awareness on this day. Epilepsy Awareness and the To get a Purple Day wristband and for more Epilepsy Ireland‘s work administration of Buccal information, visit www.epilepsy.ie or email Our support services, delivered Midazolam (BM) for healthcare [email protected]. through our offices in Dublin, professionals and those Cork, Dundalk, Galway, working in education or care Kerry, Kilkenny, Letterkenny, settings. Over 2,000 people Limerick, Sligo and Tullamore attended our training courses in 2018 and we also began are the core of our work to epilepsy for healthcare Forum estimates, based on providing BM demonstrations and will be of interest to professionals, in association international data, that at least for parents and carers. pharmacists across the with our clinical care 400 children in Ireland have Epilepsy Ireland’s award- country. colleagues and we would been affected since the 1970s. winning Training for Success Our team of Community welcome input from In February 2018, the course is currently recruiting Resource Officers are key pharmacists who would like to European Medicines Agency for the upcoming one-year contacts for individuals or contribute to the development put in place new risk term starting in August 2019. family members with epilepsy of this important resource. minimisation measures which Based at the Institute of and depending on the need Likewise, if you are aware of are being implemented in Technology Sligo, this one-year of the individual, can provide a patient who would benefit Ireland by the Health Products full time QQI Level 5 Access one-to-one support and from any of the supports Regulatory Authority (HPRA). Programme has helped over advocacy, outreach services, outlined above, please do Epilepsy Ireland welcomes the 250 young people with epilepsy educational programmes refer them to Epilepsy Ireland strengthened warnings and achieve life and career goals and self-management or contact us for more educational resources which since its inception in 1998. programmes. We also organise information. have been made available, Our newly revamped regular events and support Improving public which include patient and website, www.epilepsy.ie, groups in communities across understanding of epilepsy, professional guides, alert cards, contains useful information the country. supporting epilepsy research pharmacy posters and shelf for pharmacists and their STEPS is our six-session and advocating on behalf of barkers. These, and additional patients alike, including self-management programme people with the condition measures such as pregnancy a range of new epilepsy for people with epilepsy. It are also key objectives of prevention programmes, PL information booklets and supports people on a range our organisation. One of and SmPC updates, on-box our Epilepsy Management of issues including seizure the most important issues and blister warnings, as well as App for iPhone and Android, management, lifestyle issues, in recent times relates to reducing valproate pack sizes, which can be downloaded triggers and safety planning, reducing the risks associated will all combine to help to from the site. The app helps managing moods and with in-utero exposure to reduce the incidence of Foetal record information about thoughts, communications sodium valproate. Children Valproate Syndrome in the seizures (including video), and planning for the future. exposed to valproate in utero years to come. identify potential triggers and This course will help adults are at a high risk of serious The role of pharmacists in seizure patterns, set important with epilepsy to meet others, developmental disorders (in educating and counselling reminders, send emergency manage their epilepsy and up to 30 – 40% of cases) and patients will be a critical texts, organise medical improve quality of life. We also congenital malformations (in component in achieving this, appointments and measure offer a STEPS programme for approximately 10% of cases). building on the long-standing missed medications. parents as well as Innerwise, a While there is no official Irish and vital role played by the In 2019, we hope to develop follow-on programme designed data available, the FACS (Foetal profession in epilepsy care for a new comprehensive guide to address stress management, Anti Convulsant Syndrome) generations in Ireland.
44 IPUREVIEW MARCH 2019 CPD Marie O’Brien MPSI
Self-appraisal
Evaluate Document your learning Personal plan
Action Alopecia
Alopecia is a condition resulting in hair loss from some, or all areas of the body. Approximately 2% of people are affected at some point in their lifetime. The onset may be at any age and there is no known race or sex predominance. Onset can be gradual or sudden and hair loss associated with alopecia can be temporary or permanent.
Types of Alopecia Androgenetic alopecia is a the hairline does not recede, Risk Factors common form of hair loss it rarely leads to complete Alopecia areata (AA) is a in both men and women. In baldness. The prevalence Risk factors for hair loss chronic inflammatory disease men, this condition is known and severity of androgenetic include family history, that affects the hair follicle and as male pattern baldness. The alopecia in women increases nutrition and treatment of sometimes the nail. Alopecia prevalence and the severity greatly after menopause and the hair. Family history of areata usually presents as of androgenetic alopecia is affects about a third of white hair loss on either side of the patches of hair loss on the highest in white men, tends to women aged 70 years and older. family increases the risk of scalp but any hair-bearing skin occur less in black men, and loss. It also affects the age at can be involved. The affected later and more slowly in Asian Cicatricial alopecia is the loss which hair loss begins and the skin may be slightly reddened men. By 30 years of age, it of hair which is accompanied extent of baldness. The risk of but otherwise appears affects about a third of white with scarring. androgenetic alopecia is lower normal. Short broken hairs men. This increases to around in men with a non-balding (exclamation mark hairs) are 80% in men older than 70 Traction alopecia is a gradual father and high in those with frequently seen around the years of age. Men who present hair loss caused primarily by a balding father. margins of expanding patches with thinning hair in their late pulling force being applied to Diets low in iron and protein of alopecia areata. The nails teens or 20s are more likely to the hair. increase the risk of alopecia. are involved in about 10% of lose all their hair than those The overuse of heat and patients referred for specialist who have gradual thinning Telogen effluvium is where products on the hair such as, advice. In some people, that is not obvious until their physical, or emotional stress, straighteners and colouring larger areas are affected and 30s or 40s. Hair is lost in a may cause one half to three agents, can all contribute to occasionally it can involve the well-defined pattern beginning quarters of scalp hair to shed. an increase in hair loss. whole scalp (alopecia totalis) above both temples. Over time Hair tends to come out in or even the entire body and the hairline recedes to form handfuls while you shampoo, Causes scalp (alopecia universalis). a characteristic “M” shape. comb or run your hands Alopecia areata usually strikes Hair also thins at the crown through your hair. Crash diets, Causes of alopecia include before the age of 30. It can often progressing to partial or especially those that do not hormonal changes, medical present at any age, and males complete baldness. contain enough protein, can conditions and some and females are affected In women, the hair becomes be a contributory factor in this medications. Hormonal equally. thinner all over the head and type of hair loss. changes including factors
IPUREVIEW MARCH 2019 45 like pregnancy, childbirth or alopecia areata will progress Minodoxil is available in 2% promptly report to their GP of menopause in women can over time. and 5% solutions (Regaine®) any changes in their breast cause temporary hair loss. Other factors associated and is rubbed onto the scalp tissue (such as lumps, pain, or Medical conditions such with poor prognosis every day twice daily for nipple discharge). Depression, as scalp infections, skin include nail changes, early male and female-pattern anxiety and suicidal thoughts disorders, hair-pulling disorder onset, family history and baldness. It can slow or stop with treatment have been (Trichotillomania) and thyroid concomitant autoimmune hair loss, and may cause hair observed. Men are advised to problems can lead to alopecia. diseases. In the absence of regrowth. The solution is a stop therapy if they develop Finally, medications used treatment, female pattern hair growth simulator and depression and see their GP. for the treatment of cancer, hair loss (FPHL) leads to acts by activating potassium Unfortunately, such arthritis, depression and progressive hair loss in channels in follicular cells. treatments can be high blood pressure (calcium affected areas, though not to Effects can take 12 to 16 disheartening for patients channel blockers, beta complete baldness. weeks, and unfortunately, any with slow results and the need blockers) can be linked with The progression of hair new hair growth will fall out to use medications long-term. hair loss. loss in androgenetic alopecia two months after treatment In general, treatments are is unpredictable. In women, is stopped. more effective the earlier they it rarely leads to complete Most common side-effects are started. Newer treatments Diagnosis baldness. In untreated men, include hypersensitivity include hair transplants, The diagnosis of alopecia can hair loss progresses over time, reactions and headache. which have varying success be usually established based with some going completely The patient should stop and are an expensive solution. ® on clinical presentation. A bald in as little as five years using Regaine and see a Hair transplantation is complete blood count to and others over 15 – 25 years. doctor if hypotension is generally not an option for include ferritin levels and Often some hair is left at the detected or if the patient individuals with alopecia thyroid function to determine base of the skull and areas is experiencing chest pain, areata, as transplanted hairs any underlying issue is also above the ears. rapid heartbeat, faintness or are likely to be targeted by the helpful. dizziness, sudden unexplained immune system. Similarly, weight gain, swollen hands or individuals with a remote Treatment feet, or persistent redness or history of alopecia areata Prognosis If hair loss is caused by an irritation of the scalp or other who wish to undergo a hair infection or an underlying unexpected new symptoms transplantation for androgenic Prognosis of alopecia areata occur. Patients with known alopecia must be reminded is varied, in most cases which condition, then treatment of the infection or condition may cardiovascular disease or that alopecia areata can occur begin with a small number cardiac arrhythmia should again at any time in one’s life. of patches of hair loss, hair help to prevent further hair loss. In the case of alopecia contact their GP before If this happens, it could lead to grows back after a few ® areata, if there are signs of using Regaine . loss of the transplanted hair. months to a year, regardless Finasteride is a 5-alpha- of treatment. Some patients regrowth then no treatment is necessary; however, if there reductase-inhibitor prescribed might experience only a at a 1mg dose (Propecia®). Advice single episode of hair loss is extensive involvement then This is unlicensed in Ireland n during their lifetimes, while specialist referral is required. An important function of There is no definitive cure and and is indicated for the hair is to protect the scalp others experience multiple treatment of men with male recurrences. Some patients treatment is mainly focused from sunlight. Patients on containing disease activity. pattern hair loss (androgenetic should cover bald patches have full hair regrowth, yet alopecia) to increase hair others remain the same or Specialist treatments include with a sun block or a hat corticosteroid injections, growth and prevent further to prevent sunburn and experience further hair loss. hair loss. Hair regrowth is not In general, hair regrowth is topical corticosteroids, to reduce the chances of immunotherapy, dithranol usually noticed for at least developing long-term sun possible and known to be 4 – 6 months with finasteride. inversely correlated with cream, UV light treatment damage; (PUVA), oral ciclosporin, topical Usage is for men only and the extent of hair loss, n Some men and a few minodoxil, tattooing and wigs. again once treatment is i.e. the greater the area of women with extensive In the case of androgenetic ceased, hair loss can reoccur. involvement (alopecia totalis alopecia find that shaving alopecia, the treatments most Breast tenderness and or universalis), the less likely off the remainder of the commonly seen at pharmacy enlargement is an adverse the chance of complete hair provides a good level are topical minodoxil and effect of finasteride. Advise regrowth, and the more likely solution; oral finasteride. men taking finasteride to
“ In the case of alopecia areata, if there are signs of regrowth then no treatment is necessary; however, if there is extensive involvement then specialist referral is required.”
46 IPUREVIEW MARCH 2019 CPD overview
Self-appraisal Evaluate professional resource materials available in the pharmacy and source additional material if What do I know about alopecia and the necessary. different types? Evaluate availability of patient support materials Am I aware of the long-term prognosis for and source additional material if necessary. an alopecia sufferer? What treatments can I recommend in the Evaluate pharmacy? What support and advice can I offer patients? Consider outcomes of learning and impact of learning. Have I met my desired learning outcomes? Personal plan Do I now feel confident to engage with prescribers on how to manage drug interactions affecting the Including a list of desired learning outcomes in a personal drug excretion process? learning plan is a helpful self-analytical tool. Do I now feel confident to engage with and counsel Create a list of desired learning outcomes. patients about alopecia? How will I accomplish these learning outcomes? Provide example(s) of changes I have implemented in my pharmacy practice. Identify resources available to achieve learning objectives. Have further learning needs been identified? Develop a realistic timeframe for the plan. Document your learning
Action Create a record in my ePortfolio.
Activities chosen should be outcomes based to meet As part of this record, complete an evaluation, noting learning objectives. whether learning outcomes were achieved and identifying any future learning needs. Implement plan. Read this article on alopecia.
n Suggest joining a patient Pharmacist Support support group and meeting n other people with alopecia Hair loss can have profound Your 5-minute areata. It will make it easier psychological effects on to adjust to the condition. both patients and their assessment Alopecia Ireland www. families. It is important alopeciaireland.ie is an Irish not to underestimate the patient support group; patient’s distress and to Answer the following five questions provide reassurance; true or false: n People with longer hair n Recognise patterns of may find hair extensions 1. Almost 2% of people are affected by alopecia and recommend help camouflage the alopecia at some stage in their lifetime. problem. Some hairdressers non-prescription treatment 2. Alopecia always has a medical cause. become expert at this. It or refer where appropriate; is important to avoid too n Help identify the type of 3. Alopecia can be cured with pharmacological intervention. much tension on any hair hair loss and assess if there 4. Propecia® (Finasteride) is for use by men only. when this is done because could be an underlying 5. Alopecia areata affects men and women in equal numbers. this could cause hair loss; treatable cause (e.g. diet);
n Artificial eyelashes, and
True. True. False. False. True. 5. 4. 3. 2.
eyebrow pencils and 1. n Provide links to support Answers: eyebrow tattoos can help groups available. some people with problems in these areas; and Further references available n Eat a well-balanced on request. nutritional diet.
IPUREVIEW MARCH 2019 47 HR Hazel Slevin, MPSI, Member of the IPU Employee Pharmacists’ Committee (EPC) Assisted Decision-Making (Capacity) Act 2015
istorically there autonomy. These cases In this article Hazel Slevin was a tendency provided a cautionary warning examines the historical for healthcare to healthcare professionals professionals that a procedure or treatment and legal context to veer into performed without consent Hthe territory of paternalistic could serve as a legal wrong underpinning the recent healthcare, with the old against a patient and provide adage “doctor knows best” the basis of legal liability Assisted Decision-Making underpinning many of the against the practitioner. (Capacity) Act 2015 healthcare decisions and In response to this treatments which patients emerging patient-centric enactment and consider received. This protective approach by the courts, attitude to patient wellbeing many healthcare professions its role in the future of became increasingly at odds prioritised the development pharmacy practice. with the growing general of communication skills recognition of a person’s and proactive dialogue right to autonomy, both in with patients to obtain a the context of healthcare gold standard of consent. decisions and the normal Of course, this consent was day-to-day interactions of dependent on the patient’s individuals. A number of capacity to engage with legal cases, both in Ireland the practitioner. Patients and in other jurisdictions, with questionable capacity highlighted the importance continued to face the real of patient consent to preserve risk that the old habits of and respect this right to paternalistic healthcare of
48 IPUREVIEW MARCH 2019 “minding” the patient would to understand the “nature, decision made by the patient. decision to understand the overcome their right to purpose and effects of the The practitioner considers relevant information, retain autonomy. treatment” may be questioned. whether the decision made by it for the period necessary These cases of questioned These patients have what is the patient will achieve a good to make the decision, capacity are not harking described as “triggers”, which outcome. Again, this risked weigh up the benefits and back to the dark ages. An may require a healthcare a foray by the practitioner the consequences of that example of paternalistic professional to undertake into the murky waters of decision and communicate healthcare seeking to overbear an assessment of capacity. paternalistic healthcare. If it effectively. Taking our a patient’s ability to self- The method of assessment the practitioner didn’t think it earlier example of the patient determine is evident in the of capacity is another area was a good outcome decision, with dementia, under the English case of Re C (Adult: in which the 2015 Act has a finding of impaired capacity functional approach, the fact refusal of treatment) [1994]. C provided clarity. In Medicine, could result. that a patient may not be was a patient who suffered Ethics and the Law (3rd edn, The preferred method is able to retain the information from paranoid schizophrenia. Bloomsbury 2016), one of the functional approach to long-term does not invalidate During the course of his Ireland’s leading medical law the assessment of capacity. the decision, as long as the in-hospital treatment, he academics, Deirdre Madden, This is the method which has information is retained during suffered an infection in his describes three methods been embedded in the modern the period of time in which foot which resulted in the foot of assessment which have healthcare system by the the decision needs to be made. becoming gangrenous. The generated much discussion; 2015 Act. Madden describes A further motivator to hospital doctors sought to the status approach, the the functional assessment, or the implementation of the amputate C’s foot, to which C outcome approach and the decision-specific assessment, new Act is that Ireland vehemently objected. The case functional approach. as “defining decision-making is a signatory to the UN came before the courts and The status approach allows capacity in keeping with Convention on the Rights C was successful in his case. the practitioner to assess respect for the autonomy of Persons with Disabilities. The court acknowledged, “[T] the capacity of an individual of the individual, so that The 2015 Act was enacted he presumption that C has based on their membership of the individual’s capacity to ensure compliance with the right to self-determination a group. A common example is assessed in relation to a the Convention and to give has not been displaced. used is people with dementia. particular decision to be made, statutory effect to many Although his general capacity Under the status approach, at the time it is to be made, of the decisions which the is impaired by schizophrenia, the presumption of capacity rather than being a more courts have reached regarding it has not been established could be rebutted simply general judgement about their consent, capacity and the that he does not sufficiently because an individual has a cognitive ability”. From a very treatment of people with understand the nature, particular illness or medical basic level, this assessment disabilities. While the 2015 purpose and effects of the condition. This, at face value, method balances the patient’s Act has been signed into law, treatment he refuses.” This seems an over-generalised right to autonomy, with a many of the sections have presumption of capacity is the and simplistic tool given the recognition that the ability to not yet been commenced. bedrock of modern patient myriad of individual patient self-determine is context and Nevertheless, it is worthwhile consent principles and was factors which contribute to decision specific. for pharmacists and other later accepted by the Irish the prognosis and outcome The functional approach to healthcare professionals to courts and further enshrined of a condition. Two people the assessment of capacity familiarise themselves with in the 2015 Act. with the same condition may underpins much of the some of the sections which While the general have very different levels rationale for the 2015 Act. To will guide their healthcare principle that a patient has of capacity for a particular put it simply, one size does practice in the future. a presumption of capacity decision. not fit all. Each assessment As discussed, there is an is readily acceptable, there The outcome approach to is individual to the patient underlying presumption that are of course cases in capacity assessment considers and cognisant of the patient’s a patient has capacity unless which patients’ capacity the outcome achieved by the capability at the time of the the contrary is shown. In cases
” While the general principle that a patient has a presumption of capacity is readily acceptable, there are of course cases in which patients’ capacity to understand the “nature, purpose and effects of the treatment” may be questioned.”
IPUREVIEW MARCH 2019 49 of diminished capacity, the communicated to the DMA at relevant person on a matter centred care will be expanded 2015 Act provides a range of the request of the appointer. the subject of, or to be the through enhanced recognition supports that are in place to Part 4 of the 2015 Act subject of, a relevant decision and empowerment of promote the autonomy and provides for a Co-Decision and assist the relevant person autonomous decision-making. the dignity of the “relevant Maker (CDM). The CDM enters with communicating such The person presenting at the person”. The Act also into an agreement with the will and preferences”. The counter may not be the person addresses current lacunas in appointer and, similarly to representative has further identified on the prescription. the law relating to Advanced the DMA, facilitates in the authority “to make a relevant This is not an unusual concept Healthcare Directives and obtaining and understanding decision on behalf of the in community pharmacy Power of Attorney decisions. of information. The relevant person and shall act as it stands, yet there is For the purposes of this appointment of a CDM must as the agent of the relevant understandable hesitancy article, a focus will be placed be registered. A key difference person in relation to a relevant and concern as to how much on the support models which between the DMA and CDM decision”. This is the highest information can be disclosed may be expected to be most is that the latter makes “a level of support offered on foot or direction taken from this commonly encountered in the relevant decision jointly with of a court declaration that a third party. The 2015 Act pharmacy setting. the appointer”. In cases where person lacks capacity. when fully commenced will Part 3 of the 2015 Act the appointer and CDM differ It is notable that the 2015 help remove these grey areas provides for an assisted in the decision outcome, the Act identifies a number of of practice. The carefully decision making whereby CDM must acquiesce to the classes of individuals who designed support mechanisms the appointer enters into an appointer, unless there is a are ineligible to act in these will provide transparency for agreement with a Decision risk of serious harm to the roles including, “the owner healthcare professionals as to Making Assistant (DMA). appointer or another person. or registered provider of a who can obtain information This agreement is notified From a practice point of view, designated centre or mental on behalf of a patient, be to the Director of the a co-decision maker will health facility in which the counselled on behalf of Decision Support Service. most likely be appointed by person who intends to appoint a patient and, if capacity The DMA has a primary an individual who considers him or her as decision-making requires, engage in the role to assist the appointer that their capacity is called assistant resides”. This will decision-making process with in obtaining information, into question or may soon be prevent those operating or that patient. This is a welcome assist in understanding the called into question. employed in nursing homes in development for all patients information, to ascertain the The current ward of court which the appointer resides, including those whose will of the appointer and aid system is also restructured from acting in these roles. This capacity may be called into in the clear communication under the 2015 Act. Part is a factor of consideration question. It will also provide of that decision. A key 5 allows the court to which may be particularly greater clarity to practitioners, consideration of this role appoint a Decision Making relevant in the community at a time when there is is that the DMA does not Representative (DMR). The pharmacy setting. increased scaremongering make the decision; it is the role of the DMR is identified While these support and uncertainty as to data sole responsibility of the as “a decision-making mechanisms have yet to be protection and how it relates appointer. In the pharmacy representative shall, insofar commenced, it is important to third party representatives setting, this may result in as this is possible, ascertain that pharmacists are aware of patients. healthcare information being the will and preferences of the that the concept of patient-
What is in the File? ISO Certified The File contains information on over 63,000 products, In 2016, the IPU Product File achieved including: ISO Certification for 9001 (Quality) ISO 9001 ISO 27001 and 27001 (Information Security). Registered Registered Licensed medicinal products Quality Information Security The audit and certification process for Management Management Unlicensed medicinal products ISO Certification emphasises the robustness of the Medical devices and sundries (bandages, dressings, IPU Product File and underpins its position as the IPU PRODUCT FILE ostomy equipment etc.) definitive medicinal product catalogue in Ireland. Nutritional products, including foods for special diets Easy to Use The IPU Product File has been in existence Veterinary products The IPU Product File is an open system, so no matter what for more than 30 years and is an indispensable Photographic products vendor you choose, the file can be adapted for your needs. The IPU Product File is available by electronic download, Cosmetic products resource for community pharmacists. where you can log-in and download your monthly update. It was designed for pharmacists by pharmacists Front of Shop products (shampoos, vitamins etc.) Contact Us and is also used by doctors and hospital In addition to pricing information, barcodes etc., personnel. It is a vital support tool for the IPU Product File provides valuable professional The IPU Product File team are available to answer your queries, whether it’s on sourcing a product, pricing queries prescribing, dispensing, claiming with PCRS, information on health products. The professional information provided includes the Medicinal Product etc., the team will be able to assist you. stock ordering, stock taking, price checking Name, PA/EU number, Generic Name, Pharmaceutical For any queries relating to the IPU Product File, please and product sourcing. Form, Strength and Legal Status. contact a staff member on01 406 1550 or [email protected]
50 IPUREVIEW MARCH 2019 PROFESSIONAL Danielle Barron Report of PSI Public Council meeting of 14 February 2019
There was no gentle easing Irish Pharmaceutical Students’ been complex to implement, length. At €2.4 million over 10 into the New Year for the PSI Association (IPSA), together involving significant years, Council members will as its first Council Meeting of with the Union of Students preparation, and should be be keeping a close watch on 2019 proved to be an eventful in Ireland (USI), in relation considered to be in a “use and this, and indeed Mr Gorecki one. It was a full house in to the Masters in Pharmacy learn” phase for the initial asked if there was a potential the Fenian Street HQ, with a degree. A protest was recently period. to “freeze the brief” if costs full complement of Council held by these students, and In relation to the began to overrun. members and standing room the Council is currently forthcoming PSI Council The IIOP Strategic Review only in the public gallery, considering the report and elections, planning is now Working Group update was which was packed with petition within its remit. in progress for nominations delivered by Mary Rose Burke, pharmaceutical assistants who With the Brexit deadline and elections for pharmacist and led to dissent among had come to learn their fate. looming, the PSI is being members to vacant Council members, who queried Registrar Niall Byrne pro-active in terms of the seats in the coming months. the value of establishing a began as usual with his potential consequences on Pharmacist Sean Reilly saw separate pharmacy leadership comprehensive Registrar’s pharmacy practice. The PSI fit to criticise the inspection organisation. Ms Burke argued report. He updated now has a dedicated Brexit activities of the Council, that the PSI does have a members on the revised webpage on its site, and asking why these continued to legislative requirement to Code of Conduct, which the issues such as medicines be wholly unannounced, when advise the Health Minister Competition and Consumer supply and professional Council had agreed to move on the development of the Protection Commission recognition are already towards a mixed of announced profession. However, Vice (CCPC) has concluded that being addressed. Damhnait and unannounced inspections. President Nicola Cantwell implementing the draft Code Gaughan delivered an update Mr Byrne explained that while voiced concerns regarding the does not result in competition on Brexit preparedness from the PSI is working towards funding of this. “being prevented, restricted the working group tasked this, unannounced inspections Ms Burke summed it up or distorted”. The PSI is now with this, and explained remain a priority stating, “We by eloquently stating, “the gearing up for the launch that the PSI remains in are still finding unsatisfactory interests of the profession are and roll-out of the new Code, close contact with their UK practices in retail pharmacies not always the interests of the pending its approval by the equivalent, the GPHC. The 11 years after the regulations regulator”. This could also be Minister for Health and the group is currently examining were implemented.” applied to the long-running Oireachtas. legislation in order to see how Also deemed unsatisfactory saga regarding pharmaceutical In addition, the Pharmacy a “more streamlined” route for was the PSI’s failure to publish assistants and changes to Assessment System content recognition of those holding full documentation furnished the draft rules on temporary has been updated in line with third country qualifications to Council online; from now absence. The findings of the the review carried out in 2018, could be introduced – the UK, on, the various reports and recent public consultation Mr Byrne outlined. Version 2 of course, will become a third presentations will be found were debated and discussed of the Pharmacy Assessment country following its exit on online before the Council at length by Council members, System will be sent to all 29 March, deal or no deal. meeting. with each member speaking pharmacies in the coming Speaking of the EU, In relation to the Business at least once, if not twice, on weeks. medicines authentication Transformation Programme, the divisive issue. Graham The Registrar also outlined came into operation on 9 Fintan Foy presented the Knowles stated that after a how the PSI had accepted a February; Mr Byrne explained latest on the project, and the lengthy process, a decision is report and petition from the to attendees that this had costings were discussed at now required, but consensus
IPUREVIEW MARCH 2019 51 was not forthcoming as a wide number of Council members this would require a change Bonar put it. Following two range of views were voiced by queried the evidence base, to primary legislation. adjournments, a vote took members. Marie Louisa Power asking where was the data Much discussion centred place on what exactly would described her dismay at the on adverse events related to around what exactly the be forwarded to Minister proposed rules, saying that dispensing by pharmaceutical pharmaceutical assistants Harris. It was agreed that as one of the new generation assistants. can dispense, and the removal of Rule 8 (1) (a) of young pharmacists, she The IPU submission to rules surrounding repeat (ii) (which excluded the believed it was a “retrograde the public consultation was prescriptions and complex dispensing of certain types of step”, and asked if there was praised by many members medicines such as those on prescriptions) would satisfy not another way to address who found it reasonable in the High Tech Medicines the majority, and thus a this. Mr Gorecki admitted its ask for a less restrictive Scheme. revised set of rules was to be he had never seen such an process that would achieve What most did agree on, sent to the Minister for Health. overwhelmingly negative the same result. Proposals however, is that the issue had It remains to be seen what will response from a public for mandatory CPD for been deferred by successive happen now. consultation and said it had pharmaceutical assistants Councils and the can had given him “pause for thought”. were dismissed, however, been kicked as far down the In terms of patient safety, a with Ms Gaughan explaining road as it would go, as Hugo
” The PSI now has a dedicated Brexit webpage on its site, and issues such as medicines supply and professional recognition are already being addressed.”
PROUDLY SUPPORTING MUNSTER RUGBY
“ This tape is ideal for injuries both on and off the pitch” PHX SPORTS STRAPPING TAPE DAMIEN MORDAN A HEAVY DUTY, ULTRA-STRONG, TEARABLE TAPE, IDEAL Munster Rugby Head Physio FOR COMPRESSION, SUPPORT & FIXATION USES
Freephone: 1800 307777 Freefax: 1800 313395 Email: [email protected]
52 IPUREVIEW MARCH 2019 PROFESSIONALPOLITICS Brian Harrison Concerns raised in Dáil over Falsified Medicines Directive
As the 9 February introduction of the new ‘Safety Features’ Delegated Regulations arising from the Falsified Medicines Directive approached, the concerns of pharmacists were raised by a number of Dáil members.
Sean Haughey TD (Dublin Fine Gael); Catherine Murphy specific concerns saying, “I questions including, “the Bay North, Fianna Fáil) asked TD (Kildare North, Social recognise concerns raised by liability individual hospital the Minister for Health, Democrats); Mattie McGrath stakeholders regarding the pharmacists who are Simon Harris TD, “If his TD (Tipperary, Independent); practical implementation of employees of the HSE and attention has been drawn to Louise O’Reilly TD (Dublin the Regulation. I also want do not own the pharmacy in the concerns of dispensing Fingal, Sinn Féin); and Róisín to ensure that, above all, the which they work?” pharmacists in relation to the Shortall TD (Dublin North normal supply of medicines The subsequent guidance Falsified Medicines Directive West, Social Democrats). to patients is maintained. I provided by the Minister [and] if the concerns will be In responding to these therefore intend to implement included, “The liable parties taken into account?” Similar questions Minister Harris the system in a pragmatic and the corresponding questions were also put to explained, “The purpose of the manner and defer operating offences for this Delegated the Minister from across the Regulation is to benefit patient the offences provisions in the Regulation are in line House, including from Tommy safety and maintain confidence legislation for an initial period.” with existing legislative Broughan TD (Dublin Bay in the safety of medicines On the same topic John arrangements, governing the North, Independent); Tony supplied to them. He also Brassil TD (Kerry, Fianna Fáil) sale and supply of medicinal McLoughlin TD (Sligo-Leitrim, committed to addressing asked a series of detailed products to the public. There is nothing new in terms of the obligations under this legislation in terms of the focus of where the legal obligations lie. It is the responsibility of the body corporate to ensure that the infrastructure is in place and correctly functioning to facilitate the pharmacist Sean Haughey Simon Harris Tommy Broughan Tony McLoughlin Catherine Murphy decommissioning the Fianna Fáil Fine Gael Independent Fine Gael Social Democrats medicinal product from the national repository prior to supplying to the patient. It is also the responsibility of the pharmacist that dispenses the medicinal product to comply with their requirements under this legislation.”
Mattie McGrath Louise O’Reilly Róisín Shortall John Brassil Independent Sinn Féin Social Democrats Fianna Fáil
IPUREVIEW MARCH 2019 53 Opposition protest VAT on vitamins and supplements
There has been widespread them. He should not be paying concerning the rate of disquiet about the plans that at all. If this VAT change VAT that applies to food to standardise the rate of goes ahead, he will be paying supplements, announcing VAT on vitamins and food €86. He cannot afford that.” its intention to apply the supplements at 23%. Gino Similar concerns were also 23% VAT rate to most food Kenny TD (Dublin Mid-West, raised in the Seanad, with supplements with effect from People Before Profit Alliance) Victor Boyhan (Independent) 1 March 2019. described it as incongruous questioning whether a “It should be noted that Gino Kenny and likened it to a decision in consultation process could be human oral medicines, People Before Profit Alliance 2014 to put VAT on herbal teas established to engage on this including certain folic acid which he said, “the Minister at matter with stakeholders. and other vitamin and mineral the time abandoned.” Speaking in the Dáil, products licensed by the Richard Boyd Barrett Minister of State Michael Health Products Regulatory TD (Dún Laoghaire, People D’Arcy TD (Wexford, Fine Gael) Association, will continue to Before Profit Alliance) gave explained, “The standard apply at the zero rate of VAT. an example of a cancer rate of VAT applies to food It is possible to retain these patient called ‘Tony’ who “is supplements. However, there products at the zero rate paying €32.95 a month for is a Revenue concession because they qualify as oral Richard Boyd Barrett a probiotic; €10 for thiamin; which allows a zero rate to be medicines, which are charged People Before Profit Alliance €10 for magnesium; and €20 applied to certain types of food to VAT at the zero rate in for Vivioptal. Recommended supplements such as vitamins, Ireland under an historical by his doctor, he needs these minerals and fish oils. derogation to EU VAT law.” products for his health and “Revenue published new he is paying €70 a month for guidance on 27 December
Victor Boyhan Ministers reassured about medical supply post-Brexit Independent
Ensuring Ireland retains Shortages Framework to working group, comprising a continued supply of anticipate and manage representatives from the medicines following Brexit medicine shortages when Department of Health, the has been central to many they occur. This framework is HSE, the Health Products discussions of Brexit planning. used to manage and address Regulatory Authority and the Tánaiste Simon Coveney an average of 45 shortage Food Safety Authority, has TD (Cork South Central, Fine notifications a month. The met every week for nearly two Michael D’Arcy Gael) outlined the issue saying health system is therefore years. It has advised against Fine Gael that, “between 70% and 80% well placed to anticipate and stockpiling because it believes of all medicines in Ireland respond to any additional stockpiling may cause a will continue to come here shortages, should they break in supply, although it from the UK or through the arise because of Brexit. As is working closely with the UK. After Britain leaves the an additional safeguard, pharmaceutical industry EU, many of those products consideration is being given to and the main wholesalers to will need to have a different those categories of medicines ensure an adequate supply. It route into Irish pharmacies which are considered most has identified a watch-list of and Irish hospitals because essential to public health.” approximately 24 medicines they will no longer have The Secretary General for about which we are most the authorisation of the EU the Department of Health, concerned.” Medicines Agency in Britain.” Jim Breslin, also said, “There Minister Harris stated is no need for hospitals, clearly that, “there is no need pharmacists or patients to for hospitals, pharmacists order extra quantities of or patients to order extra medicines, or for doctors to quantities of medicines, or issue additional prescriptions, for doctors to issue additional as doing so could disrupt prescriptions. To do so could existing stock levels and disrupt existing stock levels hamper the supply of and hamper the supply of medicines to other patients.” medicines for other patients. While the Taoiseach Simon Coveney “In 2018, the HPRA also outlined Ireland’s Fine Gael developed and launched a preparations stating, “A plan multi-stakeholder Medicine has been put in place and a
54 IPUREVIEW MARCH 2019 TDs call for clarity Rural GP services debated on payments to Fianna Fáil deputy leader Dara Calleary TD (Mayo) has pharmacy students raised a topical issues debate in the Dáil in relation to GP services in rural areas. Deputy Calleary cited the areas A wide range of TDs have of Kiltane and Bangor Erris where a current GP is moving questioned the Ministers for positions leaving “members of the community concerned Education and Health in relation Michael Moynihan that they will be left without GP services.” to payments to pharmacy Fianna Fáil Deputy Calleary stated his view that the HSE should students. Michael Moynihan TD “step in and provide surgeries and facilities in the same (Cork North West, Fianna Fáil) in way that IDA Ireland provides advance factories. The HSE one of many questions put to should provide, through a public service obligation, a the Minister for Health asked subsidy towards the employment and retention of staff.” the Minister if “he will ensure Responding to the concerns, Minister of State Finian that pharmacy students will McGrath TD (Dublin Bay North, Independent) assured the be in a position to be paid for their mandatory placement.” He Dáil that “the Government is committed to enhancing Joe McHugh similarly asked the Minister for primary care services, including general practice services. Fine Gael This is central to the Government objective of delivering a Education, Joe McHugh TD, “if high-quality, integrated and cost-effective health service. the issues faced by pharmacy Our goal is to ensure that patients throughout the country students, who will now have continue to have access to GP services, and that general enormous tuition fees for the practice is sustainable in all areas into the future.” fifth year of their course, will be Minister McGrath also went on to outline how the addressed.” number of GPs has increased in recent years stating, “The Similar questions were also number of GPs on the Medical Council specialist register put to both Ministers by TDs continues to increase. They have increased from 2,270 including Margaret Murphy Margaret Murphy O’Mahony in 2010 to 3,723 as of 1 January 2019. The number of GPs O’Mahony TD (Cork South Fianna Fáil holding General Medical Services (GMS) contracts has also West, Fianna Fáil); Brendan risen from 2,098 in 2008 to almost 2,500 in 2019.” Griffin TD (Kerry, Fine Gael); Michael Healy-Rae TD (Kerry, Independent); Alan Kelly TD (Tipperary, Labour); Eugene Murphy TD (Roscommon- Galway, Fianna Fáil); Grace O’Sullivan TD (Green Party). Brendan Griffin The response of both Fine Gael Ministers was that “Any students in third-level Dara Calleary Finian McGrath institutions experiencing Fianna Fáil Independent exceptional financial need can apply for support under the Student Assistance Fund. This Fund assists students, in Call for greater availability of smoking a sensitive and compassionate cessation aids under medical cards manner, who might otherwise Alan Kelly be unable to continue their Labour Louise O’Reilly TD (Dublin Fingal, Sinn Féin) has questioned the third level studies due to their Minister on the availability of smoking cessation aids and if it financial circumstances. Details will be provided under the medical card. of this fund are available from Minister Harris responded that making nicotine replacement the Access Office in the third therapy (NRT) more widely available was a central level institution attended.” recommendation of the policy document, Tobacco Free Ireland. He said that “NRT is available to medical card holders, on prescription, on the General Medical Services (GMS) Scheme. Eugene Murphy NRT products are also available as over the counter items, Fianna Fáil without the need for a prescription. In 2014, the Health Products Regulatory Authority announced that it had licensed some NRT items for sale in non-pharmacy outlets. In addition, two non-nicotine prescription medicines are authorised in Ireland to assist in smoking cessation, and these are available in the community drug schemes.” However, he made no comment about whether NRT would be made available to medical card patients Grace O’Sullivan without the need for prescription. Green Party Louise O’Reilly Sinn Féin
IPUREVIEW MARCH 2019 55 Minister outlines response to Hydrocortisone shortage Methadone services outlined by Minister of State Catherine Byrne TD Deputies Charlie McConalogue TD (Donegal, Fianna Fáil) and Pearse Doherty TD (Donegal, Sinn Féin) questioned Minister The protocols for methadone strategy were explored in Harris on the current shortage in Ireland of Hydrocortone. In a Dáil discussion between John Curran TD (Dublin Mid response Minister Harris said, “The Department of Health is West, Fianna Fáil) and Minister of State Catherine Byrne aware of a temporary shortage of Hydrocortone (hydrocortisone) TD (Dublin South Central, Fine Gael). Curran asked the 10mg tablets in Ireland. The marketing authorisation holder has Minister “when the protocols on the methadone strategy notified the medicines regulator, the Health Products Regulatory were last reviewed and are they sufficient to ensure Authority (HPRA), that the shortage of this medicine is due to that those who want to progress from the methadone manufacturing delays. In the interim, the Irish market is being programme to become drug free can do so?” supplied on a temporary basis with hydrocortisone 10mg tablets Minister Byrne first of all outlined the uptake of from other markets to meet the needs of Irish patients until methadone explaining that “Methadone prescribing supply of the Irish authorised medicine resumes.” for opioid dependence is a key element of the harm reduction approach to opioid use set out in the national Charlie McConalogue Pearse Doherty drugs strategy. Methadone is one of the medications used Fianna Fáil Sinn Féin in opioid substitution treatment, along with Suboxone. As of 30 November 2018, more than 10,000 people were in receipt of methadone maintenance treatment.” She then outlined the protocols: “The guidelines are the first that specifically relate to opioid substitution treatment in HSE clinics and primary care settings. Opioid substitution treatment supports patients to recover from drug dependence. HSE addiction services work within the national drugs rehabilitation framework to support progression pathways. The framework ensures that individuals affected by drug misuse are offered a Deputy Brassil queries HPRA range of integrated options tailored to meet their needs and to create rehabilitation pathways.” fee increase Treatment using Suboxone was also discussed, with the Minister stating, “Suboxone use has also been established John Brassil TD (Kerry, Fianna Fáil) asked the Minister as a treatment in Ireland. To facilitate the increase in the for Health a question about the planned 8% fee increase use of Suboxone, €750,000 was allocated in each of the from the HPRA. The Minister stated that “the Authority’s years 2017 and 2018, giving us a sum of €1.5 million for last significant fee increase was in 2010. In 2011 and 2012, the full year costs.” the HPRA reduced fees, and there were no fee increases While the Minister accepted Deputy Curran’s assertion between 2013 and 2017.” that Ireland is “an outlier in comparison with most In addition, he cited Brexit and the Falsified Medicines European countries that have 20% or 30% of those on Directive as matters that will present significant opioid substitution treatment, OST, using Suboxone”, she challenges to both the pharmaceutical industry and the did say that Ireland was “heading in the right direction.” HPRA. The HPRA he said “plays a vital role in supporting this industry, and this fee increase is considered necessary in order to enable the Authority to continue to fulfil its public health remit.”
John Brassil Fianna Fáil John Curran Catherine Byrne Fianna Fáil Fine Gael Calls for extension to Meningitis B vaccine programme
Following the concerns expressed by the HSE about the increase in Meningitis B cases, a number of politicians have called for an expansion to the existing vaccine programme. Pearse Doherty TD (Donegal, Sinn Féin) expressed concern at the cost faced by families who have children born before 2016 who have “to pay for vaccination privately at a cost of between €300 and €450.” Fianna Fáil leader Micheál Martin TD (Cork South Central) said he was “perturbed” as to how the vaccine was being introduced citing the introduction of the Meningitis C vaccine which was provided to all children. Responding to a similar question from Michael Healy-Rae TD (Kerry, Independent) Micheál Martin Michael Healy-Rae Minister Harris said, “There are no plans to introduce a catch-up programme for the Fianna Fáil Independent Meningitis B vaccine to older children. Those who have a medical card are eligible to have the vaccine administered by their GP free of charge. However, the purchase of the vaccine is not covered by the medical card scheme.”
56 IPUREVIEW MARCH 2019 OBITUARY Seán Ó Duibhir, MPSI
“A close friend for well-nigh three score years”: Pádraig Ó Mathúna – Obituary by Seán Ó Duibhir
ádraig Ó Mathúna The following excerpt of Pádraig created an entire new chapter of his life in a totally was born in Cashel the eulogy delivered by his yet distinctively modern and Gaelic environment. in October 1926. He nephew, Cian O’Carroll, at his undeniably Celtic style in an Pádraig was a close friend received his early Requiem Mass illustrates the authentic way. His metalwork of mine for well-nigh three education at Cashel scope of Pádraig’s versatility. is stunningly beautiful. He score years. Our common C.B.S.P and later at Rockwell “I doubt Pádraig Ó Mathúna rejected the trend to adopt background in pharmacy, College. After leaving school passed an idle day in his life. modern techniques and while it formed a certain Pádraig embarked on a career His mind was constantly instead literally rediscovered bond between us, was in pharmacy. He studied at the whirring, while juggling what the secrets of how ancient overshadowed by our mutual School of Pharmacy, Mount seemed to be multiple strands treasures of our culture were love of our native language. Street, Dublin. He qualified of thought and argument made. He then perfected In fact, we always conversed as a pharmacist in 1955. He and creativity. This was those techniques and made “as Gaeilge”. conducted his own pharmacy reflected in the sheer breadth extraordinary and beautiful Pádraig’s Requiem Mass in Cashel from the early to the of his accomplishments. It objects with seemingly perfect in Cashel on 12 January last mid-1960’s. He subsequently seemed that everything he proportions for both secular was attended by Uachtarán managed a pharmacy in turned his hands, or mind and sacred use – objects na hÉireann, Mícheál Dónal Kilfinane, Co Limerick for to, he excelled at and he that surpass, not ape, the Ó hUigínn and was sung by Dr Rosenstock. Later on was ready to turn those great treasures of the early Cór Chúil Aodha under the he became the dispensary gifted hands to just about Christian and Bronze ages. The direction of Peadar Ó Riada. pharmacist in Carrick-on-Suir. anything. From the violin whole nation and its visitors Some haunting airs were At this stage, Pádraig and all forms of traditional can enjoy the fine collection played by members of Cashel gravitated towards the artistic music to photography, from of some of his masterworks Comhaltas Ceoltóiri. side of his being and became a stamp collecting, to archiving preserved for us all in the The chalice used in the full-time artist of exceptional important aspects of our National Museum”. mass was designed and made talent and diversity. To say island’s struggle for real and About twenty years ago by Pádraig and presented to that he was multitalented meaningful independence and Pádraig moved to West Kerry, Cashel church in honour of would be a serious from genealogy, to pharmacy Dún Chaoin to be precise. Here his late wife, Siobhán. understatement. He became and on to his best known he drew fresh inspiration from Déanaim-se comhbhrón a silversmith and goldsmith accomplishments, as an artist. the natural beauty of his new le iníonacha Phádraig – of international repute. In He succeeded in his artistic surroundings, looking out as Siobhán agus Niamh agus his younger days he won the expression across several he was from his new abode, at lena gClann uiligh. Oireachtas Gold Medal for the media. From his goldsmith the Blasket Islands. His home Ní imithe uainn, ach romhainn. violin. He was also a noted and silversmith creations, there was a veritable treasure I measc na nGael go rabh tú a philatelist, photographer, to his stunning enamelwork chest of his varied art. He chara. painter, historian and linguist. and, of course, his paintings, was happy to spend the last
IPUREVIEW MARCH 2019 57 STUDIES
CHMP recommends approval of Praluent® (alirocumab) to reduce cardiovascular risk in people with established atherosclerotic cardiovascular disease
The European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) has adopted a positive opinion for Praluent® (alirocumab), recommending a new indication as an adjunct to correction of other risk factors. Praluent® should be used in addition to a maximally tolerated dose of statin or can be used alone in patients intolerant to or inappropriate for statin therapy. The CHMP opinion is based on data from Odyssey Outcomes, a Phase 3 cardiovascular outcomes trial that assessed the effect of Praluent® in 18,924 patients who had an ACS between 1 – 12 months (median 2.6 months) before enrolling in the trial. Results from the Odyssey Outcomes trial were published in the New England Journal of Medicine in 2018. The European Commission is expected to make a final decision in the coming months. Data from Odyssey Outcomes has also been submitted to the U.S. Food and Drug Administration (FDA), with a target action date of 28 April 2019. For additional information about the company, please visit www.regeneron.com.
New Phase 3 data demonstrates superiority of TREMFYA®▼ (guselkumab) vs Cosentyx® (secukinumab) in delivering PASI 90 responses in the treatment of moderate to severe plaque psoriasis at week 48
The Janssen Pharmaceutical Companies of Johnson & Johnson announced results from the ECLIPSE study demonstrating that TREMFYA® (guselkumab) was superior to Cosentyx® (secukinumab)* in treating adults with moderate to severe plaque psoriasis for the primary endpoint assessed at week 48. Data from the multicentre, randomised, double-blind head-to-head Phase 3 study demonstrated that 84.5% of patients treated with guselkumab achieved at least 90% improvement in their baseline Psoriasis Area Severity Index (PASI) score at week 48, compared with 70% of patients treated with secukinumab (p<0.001)1. ECLIPSE incorporated six major secondary endpoints that used a fixed statistical sequence procedure to control for multiple comparisons and included both shorter and longer-term analyses. Guselkumab demonstrated non-inferiority to secukinumab in the first major secondary endpoint, with 84.6% of patients on guselkumab achieving a PASI 75 response at both weeks 12 and 48 versus 80.2% of those on secukinumab (p<0.001), however, it did not demonstrate superiority (p=0.062). Because superiority was not demonstrated for the first major secondary endpoint, p-values for all the subsequent major secondary endpoints were considered nominal1. For more information, see www.janssen.com/ireland.
References 1. Langley, RG et al. (2018) 3rd Inflammatory Skin Disease Summit 2018, 12–15 December;Vienna, Austria: LB4.
New England Journal of Medicine publishes positive results of the pivotal trial of Cablivi® (caplacizumab) for rare blood clotting disorder
The New England Journal of Medicine (NEJM) has published positive results of the Phase 3 trial of Cablivi® (caplacizumab) in adults with acquired thrombotic thrombocytopenic purpura (aTTP). The current treatment for aTTP consists of daily plasma exchange, in which a patient’s blood plasma is removed and replaced with donor plasma, and immunosuppression. Even with currently available treatments, patients continue to be at risk of developing acute blood clotting conditions, such as stroke and heart attack, as well as recurrence of disease. Cablivi demonstrated a safety profile consistent with what has been previously reported and in line with its mechanism of action; this included an increased risk of bleeding. The most frequently reported bleeding-related adverse events were epistaxis and gingival bleeding. www.sanofi.us
58 IPUREVIEW MARCH 2019 STUDIES
FDA approves Cablivi® (caplacizumab-yhdp), the first Nanobody®-based medicine, for adults with acquired thrombotic thrombocytopenic purpura (aTTP)
The U.S. Food and Drug Administration (FDA) has approved Cablivi® (caplacizumab-yhdp) in combination with plasma exchange and immunosuppression for the treatment of acquired thrombotic thrombocytopenic purpura (aTTP) in adults. Cablivi is the first FDAapproved therapy specifically indicated for the treatment of aTTP. Cablivi received FDA Fast Track designation and was evaluated under Priority Review, which is reserved for medicines that represent significant improvements in safety or efficacy in treating serious conditions. The approval of Cablivi in the U.S. is based on the results of the pivotal multicentre, randomised, double-blind, placebo- controlled Phase 3 clinical study known as HERCULES. This trial evaluated the efficacy of Cablivi in combination with plasma exchange and immunosuppressive therapy (n=72) versus placebo, plasma exchange and immunosuppressive therapy (n=73) in 145 adults experiencing an episode of aTTP. For full prescribing information, please visit www.cablivi.com
FDA advisory committee votes on Zynquista(TM) (sotagliflozin) as treatment for adults with type 1 diabetes
The Endocrinologic and Metabolic Drugs Advisory Committee of the U.S. Food and Drug Administration (FDA) voted eight to eight on the question of whether the overall benefits of Zynquista™ (sotagliflozin) outweighed the risks to support approval. Sotagliflozin is an investigational oral dual SGLT1 and SGLT2 inhibitor under regulatory review as an adjunct to insulin for the treatment of adults with type 1 diabetes (T1D). While the FDA is not required to follow the committee’s vote, the agency considers the committee’s recommendations when making its decision, which is anticipated by 22 March 2019. Sotagliflozin, developed by Sanofi and Lexicon, has the potential to be the first oral antidiabetic drug approved in the United States together with insulin therapy to improve glycemic (blood sugar) control in adults with T1D. The New Drug Application for sotagliflozin included data from the inTandem clinical trial programme, which included three Phase 3 clinical trials assessing the safety and efficacy of sotagliflozin in approximately 3,000 adults with inadequately controlled T1D. The safety and efficacy data has not yet been fully evaluated by any regulatory authority. Sanofi also submitted a regulatory application to the European Medicines Agency (EMA) in 2018. An EMA approval decision is expected in the first half of 2019. For more information, visit www.sanofi.us.
Bavarian Nordic Completes enrolment of first stage in Chordoma Phase 2 Trial
Bavarian Nordic A/S (OMX: BAVA, OTC: BVNRY) announced that the first stage of a Phase 2 study of its novel, targeted cancer immunotherapy candidate, BN-Brachyury in the treatment of advanced chordoma, has completed recruitment of the planned 10 patients ahead of schedule. The multi-site trial, which holds the potential to serve as a registration trial, aims to determine if the combination of BN- Brachyury vaccine and the current standard of care, radiation therapy, results in a clinically meaningful objective response rate (ORR) within 12 months of radiation therapy, a timeframe during which historical controls show an ORR of less than 5% with radiation alone. Radiation has been shown to inflame the tumor, releasing cancer antigens. BN-Brachyury is designed to teach T cells to attack brachyury-expressing cells and kill the tumor cells. For more information on the trial, please visit www.clinicaltrials.gov/ct2/show/NCT03595228.
IPUREVIEW MARCH 2019 59 HIGH TECH MEDICINES UPDATE Tara Kelly MPSI, Medicines Information Pharmacist, IPU Symkevi® Film- coated Tablets
ymkevi 100mg/ chloride ions helps control Adverse Reactions ciclosporin, everolimus, 150mg film-coated the movement of water in and Drug Interactions sirolimus and tacrolimus tablets, indicated tissues, which is necessary should be used with caution. for the treatment for the production of thin, The most common adverse As a precautionary measure, of Cystic Fibrosis freely slowing mucus. Disease- reactions listed in the it is preferable to avoid the use (CF),S have recently been added causing mutations in the CFTR SmPC are headache and of Symkevi during pregnancy. to the High Tech Medicines gene alter the production, nasopharyngitis. A decision must be made Scheme. structure, or stability of Liver function tests are whether to discontinue breast- Symkevi tablets contain the chloride channel. All of recommended before initiating feeding or to discontinue/ 100mg of Tezacaftor and 150mg these changes prevent the treatment every three abstain from therapy. of Ivacaftor and are indicated channel from functioning months during the first year This product is under in combination with Ivacaftor properly, which impairs the of treatment and annually additional monitoring 150mg tablets (Kalydeco) for transport of chloride ions and thereafter. (black triangle). Patients and the treatment of patients the movement of water into The use of Symkevi is not healthcare professionals aged 12 years and older who and out of cells. Cells that recommended in patients with are encouraged to report are homozygous for the line the passageways of the severe hepatic impairment suspected side-effects seen F508del mutation, or who are lungs, pancreas, and other unless the benefits are with any medicine. heterozygous for the F508del organs produce mucus that is expected to outweigh the risks. mutation with one of 14 other abnormally thick and sticky. Caution is recommended in mutations in the cystic fibrosis The abnormal mucus obstructs patients with severe renal High Tech Hub transmembrane conductance the airways and glands, leading impairment or end-stage renal As per HSE Circular 39/2018, regulator (CFTR) gene. to the characteristic signs and disease. hospitals have been requested Symkevi should only be symptoms of cystic fibrosis. Exposure to Symkevi may be to input prescriptions for prescribed by physicians with Tezacaftor is a selective CFTR reduced by the concomitant Symkevi directly onto the High experience in the treatment of corrector that binds to the first use of CYP3A inducers. Tech Hub. If a patient presents CF, following confirmation of Membrane Spanning Domain Therefore, co-administration with a High Tech prescription an indicated mutation using a (MSD-1) of CFTR. Tezacaftor with strong CYP3A inducers that is prefaced by ‘HTH’, the genotyping assay. facilitates the cellular is not recommended, nominated pharmacy can Cystic Fibrosis Ireland processing and trafficking of e.g. rifampicin, rifabutin, access the prescription details welcomed this recent addition normal or multiple mutant phenobarbital, carbamazepine, and proceed to order. In the of Symkevi onto the High Tech forms of CFTR to increase phenytoin, and St. John’s wort. event that a patient presents Medicines Scheme, stating on the amount of CFTR protein The dose of Symkevi should with a handwritten High-Tech their website, “This is the third delivered to the cell surface, be adjusted when used with prescription, you may have to in a series of groundbreaking resulting in increased chloride strong or moderate CYP3A engage with the prescriber, or and innovative drugs for CF transport in vitro. inhibitors, e.g. ketoconazole, the High Tech Co-ordination in Ireland. These are precision Ivacaftor is a CRTR itraconazole, voriconazole, Unit directly, as this patient CFTR drugs that treat the potentiator that facilitates telithromycin, clarithromycin, may not meet the criteria for underlying cause of CF and are increased chloride transport by fluconazole and erythromycin. reimbursement. aimed at particular CF gene potentiating the channel-open Ivacaftor may inhibit As for Orkambi and mutations – hence the need for probability of the CFTR protein CYP2C9; therefore, INR Kalydeco, Symkevi can only be more than one drug. The other at the cell surface. monitoring is recommended prescribed up to a maximum two CFTR drugs that were In most circumstances, during co-administration with of three months, in line with previously approved by the Symkevi will be prescribed in warfarin. Glimepiride and the reimbursement protocol Irish Government are Kalydeco combination with Kalydeco glipizide should also be used (see under the ‘Help’ Tab on (2013) and Orkambi (2017). The (Ivacaftor). The recommended with caution. the High Tech Hub). innovative deal struck in 2017 dose is one Symkevi tablet Tezacaftor metabolites The European Assessment between Vertex and the HSE taken in the morning and one have the potential to induce Report and SmPC for Symkevi provided for both Orkambi, but Kalydeco 150mg tablet taken in CYP1A2 and CYP2B6. Caution can be located on the EMA also known drugs that were ‘in the evening, approximately 12 and appropriate monitoring website (https://www.ema. the pipeline’ (i.e. undergoing hours apart. should be used when Symkevi europa.eu/en/medicines/ very positive clinical trials, The tablets should not be is administered with narrow human/EPAR/symkevi). such as Symkevi)”. chewed, crushed, or broken therapeutic index substrates of Symkevi tablets were before swallowing. CYP1A2 (such as theophylline) granted a marketing Both Symkevi and Kalydeco or CYP2B6 (such as bupropion). authorisation valid throughout Mode of Action tablets should be taken with fat- Administration of Symkevi the EU in October 2018 and are containing food. Food or drink in combination with Ivacaftor The CFTR protein is a chloride listed on the IPU Product File containing grapefruit or Seville may increase systemic channel present at the surface since the January 2019 update oranges should be avoided exposure of medicinal of epithelial cells in multiple (High Tech number: 88845). during treatment, due to their products that are sensitive organs. The transport of inhibition of CYP enzymes. substrates of P-gp. Digoxin,
60 IPUREVIEW MARCH 2019 CLINICAL TIPS Tara Kelly MPSI, Medicines Information Pharmacist, IPU
Restrictions on the use of Quinolone and Fluoroquinolone Antibiotics
he European n To prevent traveller’s their vision, taste, smell Medicines diarrhoea or to prevent or hearing. Agency’s (EMA) Adverse reactions recurring lower urinary n For patients with a safety committee tract infections; and The review found that these serious infection that is reviewed some adverse reactions can involve n To treat mild or susceptible to treatment serious, disabling and T several, sometimes multiple, moderate bacterial with these antibiotics, potentially permanent side- systems, organ classes and infections unless fluoroquinolones remain effects with quinolone and senses. The serious side- other antibiotics are an important treatment fluoroquinolone antibiotics effects include tendonitis, contraindicated. option. given by mouth, injection or tendon rupture, arthralgia, inhalation. (Ref: https://www. n Patients should be pain in extremities, gait Fluoroquinolones should be ema.europa.eu/en/medicines/ informed of the disturbance, neuropathies avoided in patients who have human/referrals/quinolone- risks associated with associated with paraesthesia, previously had serious side- fluoroquinolone-containing- fluoroquinolones prior depression, fatigue, memory effects with a fluoroquinolone medicinal-products). to initiating treatment impairment, sleep disorders, or quinolone antibiotic. It was concluded that and be advised to read and impaired hearing, They should be used with the licences for medicines the patient information vision, taste and smell. caution in the elderly, patients containing cinoxcin, leaflet. Tendon damage can occur with renal impairment and flumequine, nalidixic acid, within 48 hours of starting patients with solid organ and pipemidic acid should All suspected adverse fluoroquinolone treatment transplants. be suspended. There are no reactions associated with but the damage may be Concomitant use of licensed products marketed fluoroquinolones should be delayed several months after corticosteroids should be in Ireland containing these reported to the HPRA: stopping treatment. Patients avoided. particular agents. who are older, have renal http://www.hpra.ie/homepage/ However, use of the impairment or have solid veterinary/safety-information/ remaining fluoroquinolone organ transplantation, and Advice for Patients adverse-reaction-reporting antibiotics has been restricted. those being treated with a The following corticosteroid are at higher n Treatment should be fluoroquinolone antibiotics risk of tendon damage. discontinued and patient are licensed and marketed in should be referred to the GP: Ireland at present: Restrictions in use • At the first sign of n Ofloxacin: Tarivid; tendon injury such n Ciprofloxacin: Ciproxin, Restrictions on the use of as tendon pain or Cifox, Truoxin, Cifloxager, fluoroquinolone antibiotics inflammation; Ciplox, Profloxin; mean that they should not be • If they experience used: pain, pins and needles, n Levofloxacin: Tavanic, n tingling, numbness, Tavager; and To treat mild or self- limiting conditions, burning or weakness n Moxifloxacin: Avelox. e.g. pharyngitis, acute especially in the legs and bronchitis; arms; and Additionally, norfloxacin and • If they feel depressed n To treat non-bacterial sitafloxacin are sometimes or have problems with infections; used as an Unlicensed/Exempt memory, sleeping, or medicine in Ireland. notice changes with
IPUREVIEW MARCH 2019 61 INTERNATIONAL NEWS Róisín Molloy, Membership & Secretary General’s Office Manager, IPU International Pharmacy News
EU 3. Grant community pharmacists access to all relevant patients’ health information and the list of medications PGEU publishes its vision for they are taking; the pharmacy profession in a 4. Consult pharmacists on the integration of new digital paper titled, Pharmacy 2030: solutions in healthcare; 5. Allow pharmacists to help progress the digitalisation of A Vision for Community healthcare as trusted sources for health information; Pharmacy in Europe 6. Support pharmacists in integrating pharmacogenomics, validated clinical rules and real-world data in their daily PGEU President Michał Byliniak stated, “This year, PGEU practice to improve patient safety; celebrates its 60th anniversary. It is time to acknowledge the pharmacy profession’s vital contribution to the health of people 7. Support community pharmacists in offering health over the last decades and to look to the future to how the screening, medicines management, health promotion profession can further enhance this contribution and help to and education to help reduce the overall burden of strengthen Europe’s health systems. chronic diseases; “In light of common challenges for European healthcare 8. Establish regulatory frameworks to maximise the value systems, such as financial sustainability, shortages of healthcare of the highly-accessible community pharmacies network workers and the increasing burden of chronic diseases, we to the communities they serve; must recognise, support and develop the role of community pharmacists in providing highly accessible and quality patient 9. Ensure that community pharmacists can provide care and prevention services. patients with the full range of medicines and medical “Community pharmacists want to use their position as devices they need; and highly skilled healthcare professionals, working at the heart of 10. Ensure that remuneration for community pharmacists European communities, to further improve public health in a properly reflects their contribution to improving changing healthcare environment requiring more personalised, pharmaceutical care, reducing the burden on other patient-centred and digital focus.” health services and supporting the sustainability of health systems. Pharmacy 2030: A Vision for Community Pharmacy in Europe outlines 10 key recommendations: Source: www.pgeu.eu/en/ 1. Maximise the benefits of the community pharmacist’s intervention for patients and healthcare systems by promoting pharmaceutical services to improve treatment Australia outcomes and adherence, and to minimise risks; 2. Involve community pharmacists in collaborative Unmatched capacity and care models; capability of community pharmacists
Recently released reports from the Productivity Commission and the Pharmacy Research Centre at the University of South Australia demonstrate that an increased commitment to medication management delivered through Australia’s 5,700 strong network of community pharmacies is required to reduce unnecessary hospital admissions and emergency department presentations. The Productivity Commission found 2.9 million avoidable presentations at public hospital emergency departments in 2017 – 2018, while the Pharmacy Research Centre found 250,000 hospitalisations and 400,000 emergency department presentations annually due to medicine-related problems. These PHARMACY 2030: reports are the latest additions to the strong body of evidence A Vision for Community about the need to invest in medication management delivered through Australia’s workforce of nearly 20,000 trusted medicines Pharmacy in Europe
62 IPUREVIEW MARCH 2019 experts who work as community pharmacists in suburbs and For these resident aged care patients, their local community towns across Australia. pharmacy dispenses and undertakes, or arranges, the packing of With some 450 million patient visits a year and dispensing the medicines which have been prescribed by their doctor. The over 300 million prescriptions to patients annually, Australia’s community pharmacist takes responsibility for reconciling the established community pharmacy network is the logical and patient’s medicines with their medication chart and liaises with practical means for delivering the medication management the aged care facility, and the GP, if there are discrepancies, or reviews, adherence support and expert medicines advice that the patient has urgent or emergency medicine needs. will reduce unnecessary hospital admissions and take pressure However, this existing role can be significantly enhanced by off other already overstretched parts of the health system, such investing in personalised medication management plans for as general practice and aged care facilities. residential aged care patients that include regular quality use With the large increase in the number of Australians living of medicines support and medication management reviews with chronic diseases and co-morbidities, patients’ medication- which are undertaken by the patient’s community pharmacist related needs have become more complex and require working in collaboration with their GP. This approach will more intensive support. Investment in medication-related ensure continuity of care, timely interventions when problems collaboration between GPs and community pharmacy needs arise, maintenance of the critical links with the patient’s to be enhanced and become more formalised, with funders prescribing doctor and dispensing pharmacist, and the ongoing recognising the significant net health and fiscal dividend from provision of information to the patient’s healthcare team. This investing in medication management that is delivered through stands in stark contrast to the current medication management this established and reputable health infrastructure which arrangements in aged care facilities which are ad hoc, often underpins community-based healthcare. involve pharmacists with no links to the patient’s GP or This general practitioner community pharmacy based community pharmacist, are not undertaken on a timely basis collaborative approach to medication management, developed to prevent problems such as the overuse of anti-psychotics, and through the Community Pharmacy in Health Care Homes trial, are largely divorced from the supply of medicines. is also readily applicable to patients living in residential aged care facilities. Source: www.guild.org.au
THINKING OF A REFIT? HAVE THE RETAIL PLAN DONE FIRST. For further information on the IPU Retail Review service, please contact Darren Kelly on (01) 493 6401 / 086 028 9825 or email: [email protected]
Retail Review 190X135mm Ad ART *NEW*.indd 2 25/03/2016 16:37
IPUREVIEW MARCH 2019 63 PRODUCT INFORMATION Mundipharma biosimilar Pelmeg® (pegfilgrastim) now available in Ireland
The Mundipharma network of independent associated malignancy (with the exception of chronic myeloid leukaemia companies has announced the launch of Pelmeg® (pegfilgrastim), and myelodysplastic syndromes).ii a biosimilar of Neulasta® in Ireland following authorisation by Pelmeg® is a registered trademark of Cinfa Biotech, S.L. the Health Products Regulatory Authority. The launch follows Herzuma®, Truxima® and Remsima® are all registered European Commission (EC) approval in November 2018.i Pelmeg trademarks of Celltrion Inc. and are used under license. is the fourth biosimilar medicine to be commercialised by For further information please contact, [email protected] Mundipharma (the third in Ireland), expanding its portfolio and or 01 206 3800. commercial footprint across Europe. It was developed by Cinfa Biotech which was acquired by Mundipharma and announced i. European Medicines Agency. Pelmeg® (pegfilgrastim) European Public in October 2018. Pelmeg® is indicated for the reduction of the Assessment Report. Available at www.ema.europa.eu. ® duration of neutropenia and the incidence of febrile neutropenia ii. European Medicines Agency. Pelmeg (pegfilgrastim) Summary of in adult patients treated with cytotoxic chemotherapy for Product Characteristics. Available at www.ema.europa.eu.
Accord healthcare launch agomelatine 25mg
Accord Healthcare is delighted to announce the launch of Agomelatine Accord 25mg which is available in a pack size of 28 Film Coated Tablets. This medicine is indicated for the treatment of major depressive episodes in adults. Please refer to the Summary of Product Characteristics (SPC) available at www.hpra.ie or for Healthcare Professionals at www. accord-healthcare.ie for further information. For further information please contact Accord in Cork on 021 461 9040 or visit www.accord-healthcare.ie.
Rowex launch Desogestrel Rowex 75 micrograms Film-coated tablets
Rowex Ltd. is pleased to announce the launch of Desogestrel Rowex 75 micrograms Film-coated tablets in a 28-pack size. Desogestrel Rowex is indicated for contraception. For further information or to order contact our Rowex® Telesales Team: Irene, Jeanne Marie or Rita on 1800 304 400. Product subject to medical prescription. Further information and SPC are available from the Marketing Authorisation Holder: Rowex Ltd., Bantry, Co. Cork, P75 V009 Freephone: 1800 304 400 Fax: 027 50417 E-mail: [email protected].
64 IPUREVIEW MARCH 2019 PRODUCT INFORMATION Munster Rugby’s head physio recommends Physiologix PHX tapes for Munster Rugby players
Pictured: Damien Mordan, Munster Rugby Head Physio and Jean Kleyn, Munster Rugby.
PHX sports strapping tapes are a heavy duty, ultra-strong, tearable tape, offering excellent performance for taping applications. Ideal for compression, support and fixation uses.The Physiologix range belongs to a stable of brands from Fleming Medical, which also includes Medicare, Irelands No. 1 pharmacy-only First Aid brand. Munster Rugby uses Physiologix tapes and supports as their first choice for taping of players, both on and off the pitch. Each Physiologix product has been developed and designed to provide firm support that enables effective stabilisation and effective compression for the user. Damien Mordan, head physio with Munster Rugby, believes that Physiologix PHX tapes are of the highest quality for the Munster squad. “The PHX Strapping tape range is ideal for compression and fixation injuries both on and off the pitch for our Munster squad.” For further information, please contact Kieran Quinn, Fleming Medical 087 0624743 E-mail: [email protected]. ABC Advert JULY2014.pdf 1 28/07/2014 14:41
C ABC STOCKTAKING SERVICES
M
Y PHARMACY SPECIALISTS | SAME DAY AUDITABLE REPORTS CM LIVE STOCK INTEGRATION WITH:
MY
CY
CMY
K 44 Church Street, Tullamore, Co. Offaly Phone/Fax 057 93 20045 Alan Daly – Director 087 2666431 Darren Donoghue – Manager 086 3809082
IPUREVIEW MARCH 2019 65 NEWS PSI Strategy 2018-2020: Assuring trust in pharmacy through effective regulation
The PSI has published its new Corporate Strategy 2018 – 2020 outlining a programme of activities intended to further develop the regulator’s important contribution to assuring trust in pharmacists, in pharmacy services and the achievement of better public health outcomes. Through its role in regulating 6,050 pharmacists and over 1,900 pharmacies, the PSI will work to improve public understanding of what good pharmacy practice looks like and to assure the high standards that can be expected by everyone availing of pharmacist- provided care. This is reflected in the proposal to publish more extensive information gathered in the course of its monitoring of pharmacy services through its inspection function. This year also sees the review of the PSI’s professional Code of Conduct for pharmacists to ensure it continues to reflect the changing healthcare environment and the evolving role of pharmacists within the wider health service. As healthcare professionals, there is a need for each pharmacist to manage potential conflicts which may arise between business and organisational goals, and their own professional ethics. The Code sets out the ethical standards which govern the practice of pharmacy and which the public, patients and other healthcare professionals require and expect of pharmacists. PSI President, Rory O’Donnell, spoke about the new Corporate Strategy starting at a crossroads to change. “In less than 10 years, we have seen significant achievements in establishing clear structures of regulation. We have moved towards a more risk-based approach to inspection, for example. The education and training of pharmacy students has been radically reformed along with the requirements for the continuous professional development of existing registrants. The PSI has also supported the expansion of vaccination services within pharmacies and we have undertaken a major programme of research and stakeholder engagement, through the Future of Pharmacy Practice Report, to assess how pharmacy can help meet the future needs of patients and members of the public. Now we are going to build on our work to date, ensuring a regulatory system that affirms the trust that the public places in it and is capable of meeting future patient and health service needs.” While the implications of Brexit for the sector are still uncertain, the PSI acknowledges within the Strategy that it may be required to allocate additional resources, during the term of the plan, to manage the effects of the UK’s decision to leave the EU. The possible implications for the PSI include the movement of pharmacists between jurisdictions and the facilitation of cross-border healthcare. The PSI manages different routes of registration for pharmacists to practice in Ireland, with a large cohort coming each year from the UK, including returning Irish students. “As the impact of Brexit becomes clearer, we will work closely with the Department of Health, and other healthcare regulators in Ireland and across Europe, to minimise the negative impact on Ireland,” said Niall Byrne, PSI Registrar. Find annual service plans, reports and strategy on the PSI website, www.psi.ie.
66 IPUREVIEW MARCH 2019 NEWS
New medicines security features further protect supply chain for medicines
A new national and European system, giving patients further According to Pat O’Mahony, Chair, IMVO, “Setting up this protection from the threat of counterfeit medicines came advanced and robust verification system is a significant into effect on 9 February 2019. Throughout Europe, medicine undertaking as a result of over three years of collaboration packs will have enhanced tamper-proof measures and will by the key Irish stakeholders including pharmaceutical now carry a barcode with a unique serial number so that each manufacturers, parallel distributors, wholesalers, as well as pack can be scanned in a pharmacy. It will be checked against community and hospital pharmacists. Substantial work and a central database to ensure the product is legitimate before investment has been required by everyone in the medicines handover to a patient. Established and managed by the Irish supply chain to have the system up and running and in place Medicines Verification Organisation (IMVO), the new national as appropriate to the legislation coming into effect. Although system provides an additional layer of security to protect the there has been no risk or reported incidents at pharmacy supply of medicines at pharmacy and patient level. Ireland is level from counterfeit or falsified medicines in Ireland, other now in compliance with the EU Falsified Medicines Directive countries have had issues so this new system provides further (FMD), which provides more safeguards and security to ensure security and protection for Irish patients now and into the Irish patients will continue to have absolute confidence in the future. Counterfeit medicines can pose serious risks to health, medicines they receive from their pharmacy. as there is no guarantee of their quality or safety.” continued overleaf
Pictured above using the new system at Conefrey’s Care Plus Pharmacy, Pearse Street, Dublin 2, are: (main pic) Amy Brophy and her children Amelia and Tommy Andrews, Leonie Clarke, General Manager IMVO; (inset pic) Leonie Clarke and pharmacist Tomás Conefrey.
IPUREVIEW MARCH 2019 67 NEWS continued from previous page
The initiative has involved the collaboration of over 2,000 pharmacies, hospitals and wholesalers in Ireland HIQA announces who distribute and dispense over 95 million prescription medicines every year, as well as the manufacturers who make public consultation on the products. Each pharmacy now has a scanner to check each pack before it is dispensed to the patient. The scanner connects to a central database of prescription-only medicines C-reactive protein point- manufactured, distributed and supplied for sale in Ireland. Patients will see the new safety features appear on medicine of-care testing to guide packs as they come onto the market this year. Each pack will have a: antibiotic prescribing n Barcode (2D matrix barcode) containing data unique to that pack; and in primary care n Anti-tamper device to provide assurances that the pack has not been interfered with, e.g. glued flap, sticky seal, plastic break-seal. The Health Information and Quality Authority (HIQA) has commenced a national public consultation on Minister for Health, Simon Harris TD, said, “The purpose a Draft Health Technology Assessment of C-reactive of the regulation is to improve patient safety and maintain protein point-of-care testing (CRP POCT) to guide confidence in the safety of medicines supplied to patients. antibiotic prescribing for acute respiratory tract Nothing in the new regulations seeks to alter the existing legal infections in primary care settings. and regulatory responsibilities of persons authorised to place The objective of CRP POCT is to assist the clinician medicinal products on the market or supply them to the public. in ruling out serious bacterial infection, thereby It will apply to manufacturers, wholesalers, pharmacy owners supporting a decision not to prescribe an antibiotic and pharmacists equally. This new national system provides to those who are unlikely to benefit from treatment. further security and protection for Irish and European patients HIQA’s health technology assessment reviews the now and into the future.” clinical and cost-effectiveness of CRP POCT. The The system is based on providing an alert if the barcode is assessment will inform a decision as to whether CRP not identified when scanned. A clear protocol then follows to POCT should be used to support antibiotic prescribing investigate these alerts, involving the location where the pack in primary care for patients presenting with symptoms of acute respiratory tract infection. The assessment was scanned, the manufacturer, the Health Products Regulatory also considers the organisational implications Authority (HPRA), IMVO and its European counterpart, the associated with introducing CRP POCT in primary care. European Medicines Verification Organisation (EMVO). For the HIQA’s Chief Scientist, Dr Conor Teljeur, said, “In next number of months, medicine packs with and without the European terms, Ireland has a moderate to high rate individual serial number will be available at the same time as of antibiotic prescribing. A large proportion of those the existing stocks are gradually replaced by new packs with prescriptions are initiated in primary care for patients safety features. There is also a period of time allowed to bed in with acute respiratory infections. Most respiratory the new system across the country so alerts will be monitored tract infections are self-limiting and caused by viruses. and managed without any impact on medicine supply during Antibiotics are only useful for patients with bacterial this ‘use and learn’ phase. infections. It is not always clear if a patient presenting IMVO advises that purchasing prescription-only medicines with a respiratory tract infection has a bacterial or viral from the internet or other unauthorised sources is illegal and infection. C-reactive protein point-of-care testing can there is a high risk that these products are counterfeit, not safe support a GP in deciding not to prescribe an antibiotic. for use, and do not contain the active ingredient required to In clinical trials, C-reactive protein point-of-care make the medicine work. When you receive medicines from testing in primary care has been shown to be effective your pharmacist, always listen to their advice and follow the in reducing antibiotic prescribing without affecting steps outlined in the package leaflet. patient safety.” Counterfeit medicinal products are now officially known as The review concluded that the use of CRP POCT ‘falsified medicinal products’ under EU medicines legislation. to inform antibiotic prescribing in primary care Falsified medicines may contain ingredients which are of poor for acute respiratory tract infections leads to a significant reduction in antibiotic prescribing without quality or in the wrong dose. compromising patient safety. While there is evidence that CRP POCT has a short-term effect on antibiotic prescribing, it is unclear whether that effect is sustained over the longer term. The draft findings of HIQA’s report have been published for public consultation. HIQA invites members of the public to give feedback on the draft report until Friday 15 March 2019. You can read the draft report and take part in the public consultation on www.hiqa.ie.
68 IPUREVIEW MARCH 2019 NEWS NATIONAL National CANCER Cancer Strategy STRATEGY 2017 – 2026 2017 - 2026 Implementation Report 2018
The first implementation report on theNational Cancer Strategy 2017 – 2026, launched by the Minister for Health, sets out the progress achieved on the implementation of the 52 recommendations of the Strategy and the degree to which the key performance indicators are being met.
Prevention and Early Diagnosis highlights include: n Legislation on standardised retail packaging for tobacco; n The passage of the Public Health Alcohol Act 2018; Minister Harris said, “The challenges facing us in cancer are n The integration of cancer prevention into the messaging significant. The recent annual report of the National Cancer under the Healthy Ireland Initiative; Registry indicated that approximately 22,640 cases (excluding n Progress towards a national skin cancer prevention plan; non-melanoma skin cancers and non-invasive cancers) are and diagnosed each year. While projections indicate that the number of people with cancer will increase significantly with n The uptake rates for cancer screening. our increasing and our ageing population, we have a pathway laid out in the Strategy that will lead to many potential Highlights in Treatment and Survivorship include: cancers being prevented, and to continuous improvements n New posts in medical and surgical oncology; in the treatment and follow-up services available to patients with cancer. The past year also brought significant challenges n The commissioning of two new linear accelerators in with regards to cervical cancer. We will take a number of St Luke’s Hospital; very important steps this year towards achieving our goal of effectively eradicating this cancer.” n The progress of construction work on a new radiation The Implementation Report 2018 can be found at oncology centre in Cork University Hospital towards www.health.gov.ie. completion in Q1 2019; n Publication of a Model of Care for Oral Anti-Cancer Medications; n The commencement of the roll-out of a National Cancer Information System; n The progress being made by Working Groups on Survivorship and Psycho-Oncology; n The appointment of a National Clinical Lead for psycho-oncology; and n Establishment of a Cancer Patient Advisory Committee.
IPUREVIEW MARCH 2019 69 NEWS
Irish Skin Foundation Dermatology Study Day 2019 – 6 April 2019
The Irish Skin Foundation (ISF) has announced details of its 4th annual Dermatology Study Day which takes place on 6 April 2019 in the Ashling Hotel, Parkgate Street, Arran Quay, Dublin 8, from 9th All Ireland 9.00am – 3:55pm. The 2019 programme is designed for hospital and Pharmacy Conference community-based pharmacists, GPs, public health nurses and others involved in providing first-line management of skin conditions/diseases. The – Call for Abstracts programme will cover first-line management of: Burns and Abrasions; Paediatric Skin Conditions; Rosacea; Alopecia; Hidradenitis Suppurativa (HS); The All Ireland Pharmacy Conference now invites and Skin Cancer Recognition. submission of abstracts for the 2019 conference. The Dermatology Study Day will be chaired by The 9th All Ireland Pharmacy Conference will be held Carmel Blake, Dermatology ANP at Tallaght University at Ballymascanlon House Hotel, Dundalk on 14 and 15 Hospital and ISF Helpline Clinical Manager. October 2019. Registration Fee: €75 including tea/coffee and The conference is themed around the FIP lunch. For details on the full programme, please visit Pharmaceutical Workforce Development Goals. www.irishskin.ie. Abstracts are invited that deal with a broad range of pharmacy practice, including (but not limited to) the following areas: n Competency development (FIP Goal 5); n Advanced practice and specialisation (FIP Goal 4); Cystic Fibrosis Ireland n Workforce impact (FIP Goal 11); and gets set to host national n Working with others (FIP Goal 8). Abstracts can be submitted on the IIOP website, www.IIOP.ie/AIPC2019. The closing date for receipt of conference for CF abstracts is Friday 10 May 2019 and authors will be notified regarding acceptance by Friday 21 June 2019. Community – 12 April 2019 The organising bodies will cover the conference costs for the main presenter of each oral presentation. For those presenting posters, the day delegate fee will Registration is now open for Cystic Fibrosis Ireland’s (CFI) be covered. annual conference, which will take place in the Mount Wolseley Hotel, Carlow, on Saturday 30 March, entitled 2009 – 2019: A Decade of Progress, but many Challenges Ahead. The conference takes place ahead of CFI’s annual fundraising flag day, 65 Roses Day, on Friday 12 April, when people are urged to buy a purple rose for €2 or donate online at www.65RosesDay.ie. Among the speakers will be Prof. Barry Plant, Cork University Hospital, who will address new CF drug therapies in the pipeline, while Dr Michelle Murray, Mater Hospital, will update on transplants and organ donor consent developments. For further information and to register, please visit www.cfireland.ie. The conference will also be streamed online at www.cfireland.ie.
70 IPUREVIEW MARCH 2019 NEWS Accord Healthcare Daffodil Day launches High Tech more important Hub Demo Video than ever with PharmaBuddy Daffodil Day 2019 takes place on 22 March and members of the public are urged get involved by volunteering to help fundraise on www.cancer.ie and The High Tech hub was introduced to all pharmacists by the donating what they can on the day. HSE in March 2018 in an effort to streamline administration of RTÉ Weather and National Lottery presenter Nuala the scheme for pharmacists and to provide enhanced visibility Carey has appealed to the public to shower Daffodil Day of stock management and spending on this scheme to the with donations, in the wake of her father’s death from HSE. After speaking to customers, Accord Healthcare identified cancer in November. “Pancreatic cancer currently has that many pharmacists have concerns with using the Hub. the lowest survival rate for all major cancers, with just Accord therefore approached PharmaBuddy with the idea of one in ten people alive five years after diagnosis. We can, creating a demonstration video and answering any queries and must, change this, but it will require much more pharmacists may have in relation to the High Tech Hub. investment in cancer research and services. That’s why I Marguerite Tierney, Accord’s PR & Marketing Manager, am appealing to everyone to get involved and help make explains, “PharmaBuddy, the online resource for Irish Daffodil Day 2019 bigger than ever. Your donations will pharmacists, conducted further research with their also fund vital supports for patients and their families, pharmacist members. They received a number of queries so no one has to go through cancer alone.” from pharmacists such as ‘how to tell if stock is dispatched’, Averil Power, Chief Executive of the Irish Cancer ‘what happens if the Hub generates a warning’ or ‘can the Society, said, “Last year, our nurses, staff and volunteers user dispense a medicine from the Hub if the prescription reached thousands of patients affected by cancer, but was written inside the EU but out of the State’; from we didn’t reach everyone in need. We don’t just want there, a short demonstration video which covers all the to provide an excellent service to some cancer patients, aforementioned issues and many more, was created.” we want to provide it to all cancer patients. As 98% of The video will sit on the PharmaBuddy website, accessible our funding comes from the public, we simply can’t do to all registered pharmacist members, and also on the that without more donations.” High Tech page of the Accord Healthcare website To view the Irish Cancer Society’s Research Plan 2019 www.accord-healthcare.ie. or for further information on Daffodil Day, please see www.cancer.ie.
Pictured at the launch of the Accord Healthcare High Tech Hub Demo video are Marguerite Tierney, Accord Healthcare and Dr Paul Ryan, Pharmacist, GP & founder of PharmaBuddy.
IPUREVIEW MARCH 2019 71 NEWS Ministers for Health and Agriculture publish Over 600 life-saving report on antimicrobial defibrillators use and resistance across four
The Department of Health and the Department of Agriculture, Food and the Marine have published the Ireland – One Health Report manufacturers on Antimicrobial Use & Antimicrobial Resistance. This report provides, for the first time, a snapshot of the antimicrobial use (AMU) and require urgent antimicrobial resistance (AMR) in both humans and food-producing animals in Ireland. The World Health Organisation defines antimicrobial resistance as updates the resistance of a micro-organism to an antimicrobial drug that was originally effective for treatment of infections caused by it. This One Health report shows that data in Ireland on AMU for The Health Products Regulatory Authority humans and food-producing animals is improving all the time. (HPRA) is urging owners of automated However, gaps remain in the information available, namely; external defibrillators (AEDs) to check that the recommended safety and n Although data for approx. 90% of acute hospital and 95% of maintenance updates on their device have public prescription antimicrobial use is available, there is no been undertaken. All individuals who are data for available for private prescription antimicrobial use; in possession of an AED are advised to n Surveillance of human AMR reflects invasive infections only urgently check if their device is one of the (Blood Stream Infections (BSIs) in acute settings) and not on models below. If they have an affected AED, other infections (Urinary Tract Infections (UTIs) and wound the HPRA urges the owners to contact the infections) outside of the acute setting; manufacturer or the HPRA to ensure their AED receives all necessary updates. n Currently, information from national surveillance of AMU An estimated 614 AEDs by four different does not include information on the appropriateness of the manufacturers require urgent updates in antimicrobials used in either sector; Ireland to ensure they will work correctly n There is no specific surveillance for AMR in imported food in an emergency situation. Without these products; and updates, the AED may not work as intended. The devices may require a software upgrade n There is also no systematic surveillance for AMR in the – similar to upgrading software on your environment. phone or computer – or the replacement of Commenting on the publication of the report, Minister for Health a component part within the AED. Simon Harris TD said, “We know that the emergence of AMR Since the HPRA’s previous announcement worldwide is a real and growing public health crisis and we are in November 2017, 95 AEDs have had likely approaching a tipping point if antibiotic resistance continues completed updates that were outstanding unchecked. There are some stark reminders of the consequences of at that time and the HPRA is now calling on AMR when we consider the outbreaks of Carbapenemase producing other owners to do the same. Commenting, Enterobacteriaceae (CPE). In adopting the One Health approach, it Anne Tobin, Medical Devices Vigilance is acknowledged that sectors on their cannot properly address this Manager of the HPRA, highlighted the concern in isolation and a joint, co-ordinated approach is required.” positive progress made by owners who are Further information is available at www. health.gov.ie. proactively liaising with the manufacturers. “It is very encouraging to see that manufacturers are reviewing their devices, identifying shortcomings, and taking action. We are urging owners of AEDs to be vigilant and to check if they have one of the affected AEDs and, if they do, to liaise with manufacturers to ensure the devices are updated without delay. This year, 614 Ireland automated external defibrillators in Ireland One Health Report on Antimicrobial required an urgent update, without which Use & Antimicrobial Resistance the devices may not perform in a life- threatening emergency’’. Further information may be found on the HPRA’s website, www.hpra.ie.
72 IPUREVIEW MARCH 2019
Ireland’s first One Health Report on Antimicrobial Use and Antimicrobial Resistance 2016
January 2019
16 NEWS Minister for Health appoints HSE board members on administrative FSAI publishes basis updated national
The Minister for Health, Simon Harris TD, announced healthy eating eight new appointees to the Board of the HSE. The Board will be appointed on an administrative basis until the legislation has passed. These positions were advertised through the State Board process operated guidelines by the Public Appointments Service. They will join Ciarán Devane, announced as Chair of the HSE Board The Food Safety Authority of Ireland (FSAI) has in September 2018. published the updated Healthy Eating, Food Safety and The new appointees are: Food Legislation – a Guide Supporting the Healthy Ireland n Fergus Finlay, former CEO of Barnardos; Food Pyramid. According to Dr Pamela Byrne, CEO, FSAI, “The guide n Tim Hynes, Group Chief Information Officer, AIB; is a combination of international best practice with n Prof. Deirdre Madden, Professor of Law at UCC up-to-date Irish research to ensure the advice meets and Chair of the Commission on Patient Safety the specific dietary needs of the Irish population. and Quality Assurance. Dr Madden will be It provides food-based advice that protects people appointed Deputy Chair of the HSE Board; from five years of age onwards against diet-related ill health such as heart disease, cancer, obesity and n Dr Sarah McLoughlin, Science and diabetes, which are major causes of ill health in Communication Officer at Retina International Ireland. It gives this advice across four age groups and patient advocate; from five to 51+ years with distinct information for n Mark Molloy, Quantity Surveyor, member of the those leading active and non-active lifestyles.” Expert Group on Tort Reform and Management of Developed in conjunction with the Department of Clinical Negligence Claims and patient advocate; Health and the Health Service Executive, the guide covers portion sizes and servings, tips for choosing n Aogán Ó Fearghail, former GAA President; the healthiest types of foods, as well as reducing risks n Fiona Ross, Chair of CIE and Mental Health during cooking. It also covers: Ireland; and n Nutritional composition – how various foods n Dr Yvonne Traynor, Vice President of Regulatory best meet different people’s needs; and Scientific Affairs with Kerry Group. n Food safety – microbiology, harmful bacteria, At the time of printing there remained one final viruses and how these can be minimised; and position on the Board to be filled which will have n Food law – to ensure businesses are aware of particular relevance to the competency area of legal requirements to provide consumers with financial planning and management. accurate information on nutritional labelling and allergen declarations. The Guide is available on the FSAI website, www.fsai.ie.
IPUREVIEW MARCH 2019 73 CLASSIFIEDS
FULL-TIME CHIEF 1 PHARMACIST Want to increase your REQUIRED – DUBLIN Pharmacy’s margins? St Patrick’s Mental Health Services requires a full-time Chief 1 Pharmacist Xsulent Consultancy specialise in the area of drug pricing and The successful applicant must: purchasing working with wholesalers and manufacturers to get the best • Be a registered Pharmacist with the Pharmaceutical , deal for your pharmacy. Society of Ireland (PSI) or be entitled to be so registered • Have at least five years satisfactory post registration hospital experience • Possess a high standard of For professional advice and a free consultation, contact David Murnane administrative, managerial or business ability • Possess on 0851157435 or [email protected] the requisite knowledge and ability (including a high standard of suitability and management ability) for the proper discharge of the duties of the office. Contact Brian Davitt: [email protected] ph: 01 249 3639
PROPERTY FOR SALE. TIPPERARY (Large town). Great FULL-TIME PHARMACIST potential as pharmacy / health centre. Near four nursing homes. Enquiries in confidence to PO Box 119 REQUIRED – TIPPERARY PHARMACY FOR SALE. CORK. Excellent business opportunity. Enquiries in confidence to PO Box 718 Costigan’s Pharmacy, Blind Street, Tipperary Town, requires a full-time Pharmacist. PHARMACIST SEEKS TO PURCHASE PHARMACY. CORK CITY OR COUNTY. All options considered. Recently relocated pharmacy, with a busy Reply in confidence to PO Box 818 dispensary and innovative design. Heavily ALL BOX NUMBER REPLIES SHOULD BE POSTED TO: health-care focused. Two pharmacists on duty, Irish Pharmacy Union, Butterfield House, as well as experienced technicians. 30 minutes Butterfield Avenue, Rathfarnham, Dublin 14. from Limerick, 60 minutes from Cork. This independent service is free to IPU members. No late nights. Working one Saturday in three. Entries will be deleted after three months. Excellent package for the right candidate. Advertisements should be forwarded to Sinéad Fennell Email Siobhán: [email protected] by email to [email protected]. or phone 086 880 4924
Irish Chemists’ Golfing Society News
The new season of the ICGS Golf outings will get underway in Monday 9 September Killarney March. Please find below the fixtures for 2019: Sunday 29 September Rosapenna Hotel & Golf Resort Tuesday 26 March The Island Golf Club (GOY Finals) Monday 15 April Naas Golf Club Monday 30 September Rosapenna Sunday 19 May Tramore Golf Club Incoming Captain for the year is Mr Patrick Digan, and newly Monday 20 May Tramore elected President is Mr Frank Reen. New members are always Tuesday 21 May Tramore (Captain’s Prize) welcome, and all standards Sunday 16 June Druids Glen Hotel & Golf Club of golf are catered for. (ICGS VsUCGA) Monday 17 June Druids Glen Thursday 11 July Carlow Golf Club Tuesday 13 August Portmarnock Golf Club Sunday 8 September Killarney Golf & Fishing Club (President’s Prize)
74 IPUREVIEW MARCH 2019 CLASSIFIEDS Brenson Lawlor Box Advert option 2.pdf 1 12/06/2017 08:28
Have You Considered FULL-TIME SUPERVISING the Value of Your Pharmacy? PHARMACIST REQUIRED C M JPA Brenson Lawlor can independently value your – CORK Y business so that you can ascertain how much it is worth. Haven Pharmacy Burke’s, Macroom, CM Co. Cork, requires a full-time MY Contact Us Today for A Free Consultation. Supervising Pharmacist. CY Excellent conditions. CMY Telephone Jason Bradshaw K or Padraic Ferguson on No late nights or Sundays. 01-6689760 Contact Seamus on 087 698 1634 or email CV to [email protected] www.brensonlawlor.ie
SUPPORT PHARMACISTUntitled-1 1 FULL-TIME DISPENSING12/06/2017 12:05 REQUIRED TECHNICIAN REQUIRED PHARMACY PLUS BIRR – DUBLIN 9.30am – 6.00pm, Monday – Saturday. No Sundays. No Bank Holidays. Experienced technician required for South No Late Nights. Lunch Break Everyday. Co. Dublin pharmacy (near Dun Laoghaire). Excellent Work Systems. Award Winning Team. Four days per week, with one Saturday in Full-time available but Part-time will also be four. Experience with OTC also helpful. considered. Pharmacy open 9.00am – 7.00pm, Monday to Friday, and 9.00am – 6.00pm, Saturdays. Email: [email protected] David 087 232 2905 Email CV to May Gallagher [email protected] FULL-TIME PHARMACIST REQUIRED IS THE JOB DONE? Achieving Tax-efficient financial security for – DUBLIN Pharmacy Owners using Company Cash, Property, Pensions and investments. Foxrock Pharmacy, Dublin, requires a full-time Pharmacist. Busy pharmacy Contact: Joanne Fenelon or Jim Doyle on 01 526 7770 Enquiries to: [email protected] and very pleasant place to work. Guardian Wealth Limited trading as Guardian Wealth, t/a ARF Ireland,is regulated by the Central Bank Of Ireland 40569. Guardian Wealth Limited is registered in Enquiries by email to [email protected] Ireland at 3 Upper George Street, Wexford. Company Registration Number 399683
To advertise here, contact Sinéad at [email protected]
IPUREVIEW MARCH 2019 75 CA Advert A4 2019.pdf 1 26/10/2018 10:45
CHRISTMAS Cosmetic & Gift Trade Fair 2019
The Main Hall, RDS, Ballsbridge, Dublin
Sunday 19th May 10am - 6pm
Monday 20th May 9am - 6pm
Tuesday 21st May 9am - 6pm
www.cosmeticassociation.ie