- for warts and verrucas

Kind therapy...not cry therapy

Supplied in a complete treatment kit, with a simple once daily application, Salatac Gel offers a very convenient and painless way of treating warts and verrucas. Salatac Gel dries to a water-resistant film... no need for plasters.

Recommend

Prescribing information

Salicylic acid 12.0% w/w, lactic acid 4.0% w/w.

Uses: For the topical treatment of warts, verrucas, corns and calluses.

Directions: Adults, children and the elderly: Apply once daily until the wart, verruca, corn or callus has disappeared (treatment may take up to 12 weeks). Soak the affected area in warm water for 2-3 minutes and dry with patient’s own towel. Carefully apply one or two drops to the lesion avoiding the surrounding skin. (Peel off the previous day’s gel before reapplying). Once a week gently rub away the treated surface with an emery board to remove any hard skin before re-application of the gel.

Contra-indications, warnings, side effects etc: Please refer to SPC for full details before prescribing. Do not use if sensitive to any of the ingredients. Not to be used on or near the face, intertriginous or anogenital regions, or by diabetics or individuals with impaired peripheral blood circulation. Not to be used on moles or on any other skin lesions for which it is not indicated. Keep away from the eyes, mucous membranes and from cuts and grazes. Some mild, transient irritation may be expected, but in cases of more severe or persistent pain/irritation, the treatment should be suspended or discontinued. Avoid inhaling vapour. Highly fl ammable, keep away from fl ames.

Package quantity, trade price and MA number:

8g tube with applicator. € 5.86, PA23128/007/001

Legal category: Supply through pharmacy only.

Further information is available from: Dermal Laboratories (Ireland) Ltd, Head Offi ce Tatmore Place, Gosmore, Hitchin, Herts, SG4 7QR, UK.

Date of preparation: February 2021 iSIMPATHY patient cohort: iSIMPATHY aims to target those patients at greatest risk of inappropriate polypharmacy:

‘Salatac’ is a trademark.

Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie. Adverse events should also be reported to Dermal.

• Prescribed 10+ regular medicines,

• On medication or combinations considered particularly highrisk for adverse events such as bleeding or acute kidney injury,

• Adults of any age, approaching the end of their life due to any cause, or

• Aged 50 years and older and resident in a residential care setting e.g. nursing home, intellectual disability residential setting or community hospital.

Incorporation of iSIMPATHY medicines reviews into GP Practice

Patients likely to benefit from a review are identified from referrals from GPs, community and hospital pharmacists, practice and hospital nurses and through the pharmacist identifying suitable patients from audit of the GP practice records. The pharmacist contacts the patient and provides information about the review process. If the patient agrees, a suitable appointment is arranged (face to face or telephone consultation). The patient (and/or carer) then meet with the pharmacist to carry out a comprehensive, person-centred medicines review. Reviews begin with what matters to the patient, identifying which medicines are essential, unnecessary, effective or ineffective, harmful or have the potential to harm and if more cost effective alternatives would be appropriate. The pharmacist and patient agree an approach to adjusting medicines.

The pharmacist then provides the patient’s GP with a summary of the review and recommendations. The GP considers these recommendations and actions them as appropriate. The pharmacist follows up with the patient to discuss their experience with the changes.

Within GP practice, areas that have benefited from the presence of iSIMPATHY pharmacists include:

• Adding capacity - iSIMPATHY pharmacists have time to spend with patients to go over their medication in depth and to the patient’s satisfaction.

• CDM clinics: Medicines reviews delivered prior to the GP’s review of the patient under the Chronic Disease Management scheme has been found to be particularly effective and efficient. Pharmacists readily recruit new patients to CDM also.

• Effective contact with secondary care providers.

• Review of patients recently discharged from hospital.

• Antimicrobial Stewardship (e.g. 85% of long term antimicrobials were stopped following iSIMPATHY medicines review).

• Review of nursing home residents.

• Implementation of national guidance - Medicines Management Programme, PCERS and medication safety updates.

• Medicines Information.

• Contact with community pharmacies.

• Update of practice protocols.

• Provision of education and access to training resources e.g. Polypharmacy and Medication review online course currently available on the IIOP website (Polypharmacy eLearning will be available via HSeLand shortly).

Outcomes of iSIMPATHY to date:

• Over 2,500 reviews completed (March 2023).

• 98.2 % of iSIMPATHY pharmacist recommendations were accepted by the GP.

GP experience:

• Project GPs and pharmacists report iSIMPATHY is having positive effects on patient safety, quality of life, satisfaction, understanding, adherence and quality of care, and a positive effect on GP job satisfaction, knowledge and understanding.13

• GPs believe pharmacist knowledge and skills, capacity (time) to carry out reviews and pharmacist communication with the patient are key facilitators to the success of the project.

• GPs’ capacity (time available) to engage with the project is a challenge raised by both GPs and pharmacists. Pharmacists have worked with GPs and practice staff to streamline the service to avoid excessive GP workload, e.g. condensing review outcomes to a ‘5-minute read’ report, time allocated in GP schedule to review and enact the report.

• There is unanimous support for project to continue. GPs and pharmacists are also eager to see the role of the iSIMPATHY pharmacist expanded within the practice.

GP feedback:

Dr Majella Grealish, Bayview Family Practice, Ballyshannon:

“… the iSimpathy project contributes in a tremendous way to our practice. We no longer look at patients on large numbers of drugs and wonder where to start with rationalising them. As you are well aware, these are generally old and / or vulnerable people in society. In the past we may have tried to rationalise their medications, but this is too time consuming an endeavour for GPs. That is apart from the fact that pharmacy is not our speciality.

Dr Grace Kenny, The Square Medical Centre, Dundalk:

“From my point of view, Leon’s work and input are invaluable. His approach is patient-centred, encouraging, and empathetic. I have had only positive feedback from the patients, who are willing to either take, cut down, change, or cut out certain medication.

• His suggestions of change are always backed by guidelines, which he presents in typed format, making the changes easy to understand and comply with.

• I know I now find myself much more aware of polypharmacy and non-compliance, and I am putting some of what Leon has suggested into practice so it’s a win-win situation for both doctors and patients”

Complexity, deprescribing and Safety outcomes:

• Complexity: o Mean patient age 77 o Mean of 7 comorbidities.

• Number of pharmacist interventions: A mean of 13 issues are addressed per patient (drug changes, education, monitoring, referrals, medication reconciliation and updating practice records). 80% are classified as significant or very significant and improving patient care; 33% of patients reviewed had an issue addressed which was classified as very significant, preventing a major organ failure or adverse reaction of similar importance.

• Deprescribing: A mean of 14 medicines pre- and

12 medicines post-review. The deprescribing process may be more complex and challenging than the initiation of drug treatment. iSIMPATHY pharmacists ensure that deprescribing is conducted is a safe, appropriate and evidence based manner.

• Safety: At least one Polypharmacy Indicator was identified for approximately 75% of reviews. These indicators flag that a serious adverse outcome is possible. 69% were resolved through iSIMPATHY medicines review.

Economic outcomes:

Although the primary purpose of polypharmacy reviews is in deriving clinical and quality of life benefits, they also deliver long-term direct and indirect economic benefits.

• Cost savings per review = ¤412

• Direct drug cost savings to HSE Mean ¤375 (95% CI ¤217 to 542)

• Hospital admission due to ADR avoidance: ¤36 per review

• Cost per review = ¤204

• 10 medicines reviews per working week per pharmacist (450 pa)

• Payscale + PRSI + equipment + travel & subsistence

• GP payment per review

• Net cost savings per review = ¤208

Patient experience:

• Patient, carer and family acceptability is high, with very high uptake of reviews and agreement with changes and very positive feedback received.

Patient feedback

“I’m not bleeding as often since my medication review”

“I’m definitely less short of breath and dizzy now”

“Once u got over the hump of withdrawing from Diazepam, I felt much better and my walking has improved greatly”

MSc in Clinical Pharmacy at UCC

“Pains in my legs used to limit my walking distance, but this improved after my medication review”

“Dad’s mood and appetite are much better since his medication review”

“There was a definite improvement in my constipation and shortness of breath. I had no idea that changing my tablets could help with these things”

The iSIMPATHY project is funded to March 2023. The project team are working to ensure high quality evaluation and publications to share the learning from this successful project in the Republic of Ireland. The benefits and strengths of this service have been acknowledged within the HSE and options for mainstreaming are being explored.

Further information on iSIMPATHY is available via www.isimpathy.eu or by contacting iSIMPATHY Project Manager Celine Croarkin via Celine.Croarkin@hse.ie

References available on request

GP Practices Participating in iSIMPATHY:

Bayview Family Practice, Bundoran and Ballyshannon, Donegal

Medicentre Barrack St, Sligo

Strandhill Surgery, Shore Road, Sligo

Dromahair Health Centre, Leitrim

Ballyjamesduff Family Practice, Cavan

Kingscourt Surgery, Cavan

Elm Surgery, Drumalee, Cavan

The Group Practice, Carrickmacross, Monaghan

The Square Medical Centre, Dundalk, Louth

Northgate Surgery, Drogheda, Louth iSIMPATHY Project team

Project Lead: Ciara Kirke, Clinical Lead, National Medication Safety Programme, HSE Quality & Patient Safety Directorate

Senior Clinical Pharmacists: Clare Kinahan, Emma Jane Coyle, Jacqueline Treacy, Leon O’Hagan, Niamh Feeley

Project Manager: Celine Croarkin

HSE Primary Care Pharmacists: Joanne O’Brien and Trevor Hunter

Therapeutics Lead, ICGP: Dr Paul Ryan

HSE Steering Group: Joseph Ruane and Dermot Monaghan

Applications are invited for this two-year (part-time) distance learning Master’s Degree offered by the School of Pharmacy, University College Cork course, commencing in September 2023.

The course is structured to provide specialist training to enable pharmacists working in hospital and community pharmacies to extend their professional role within the evolving clinical healthcare system.

The course will promote a greater understanding of the major pharmacotherapeutic issues of various disease states in order to develop a greater understanding of the particular needs of patients with these diseases.

Graduates will gain the skills needed to become leaders in clinical pharmacy services, such as critical appraisal of drug therapies, rational drug use (including pharmacoeconomic evaluation), medication safety management, research project management, presentation skills and report writing.

The flexible, online learning format allows students to remain employed throughout the course. Students will be able to interact with each other and the experienced medical and pharmacy practitioners via webinars, video conferencing, and online discussion boards.

Applicants must hold a primary pharmacy degree and, ideally, have a minimum of one-year practical experience. Applicants must be registered as a pharmacist with the professional accreditation authority in the country where they practice.

Visit MSc Clinical Pharmacy online at www.ucc.ie/en/ckx03 to learn more about the course.

Closing date for applications: 30th June 2023

Applicants must apply online at www.ucc.ie/apply. Full details of the application procedure are available on this website. For further information please contact Dr Suzanne McCarthy (Interim Programme Director, S.McCarthy@ucc.ie) School of Pharmacy, University College Cork, Cork, Ireland.