March 2019 Volume 11 Issue 3 PHARMACYNEWSIRELAND.COM
THE INDEPENDENT VOICE OF PHARMACY
In this issue: NEWS: Is medicines pricing ‘predatory’? Page 5
MAMA MOBILE APPLICATION
Professor Pat O’Mahony on the work of IMVO Page 9
Paperless Medication Management
Bottom line with Ireland’s Generics Market Page 16
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Study shows pharmacy facing uphill struggle Page 25
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CPD: Management of Allergies Page 39
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Launch of the 2019 Irish Pharmacy Awards Page 49
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Page 5: IPHA hit back at ‘predatory pricing’ claims
Pressure is being firmly placed on the Government by the community pharmacy industry to ensure promises are fulfilled, before the profession begins to face an upward struggle to attract newly qualified pharmacists to the sector.
Page 6: Perspectives of Community Pharmacy highlights startling results
On page 6, the Irish Pharmacy Union (IPU) states that government failure to deliver on its promise to expand the role of community pharmacies has the potential to undermine their future.
Page 12: Delegated Regulation on safety features
The IPU made the calls as new research has shown found that Irish pharmacists regard helping patients and the public as the most satisfying part of their job. However, too much red tape and a lack of progress towards evolution of the pharmacist role was the biggest drawback to attracting graduates to community pharmacy and retaining pharmacists in their current roles.
Page 16: What’s the bottom line in Ireland’s generics market?
Turn to page 26 for full details and findings from the research.
Page 49: Launch of the 2019 Irish Pharmacy Awards
After many, many months of discussions and debates regarding the Falsified Medicines Directive, it finally came into force last month. The initiative has involved the collaboration of over 2,000 pharmacies, hospitals and wholesalers in Ireland who distribute dispense over 95 million prescription medicines every year, as well as the manufacturers who make the products.
Professor Pat O’Mahony, Chair of the Irish Medicines Verification Organisation (IMVO) says, “Setting up this advanced and robust verification system is a significant undertaking as a result of over three years of collaboration by the key Irish stakeholders including pharmaceutical manufacturers, parallel distributors, wholesalers as well as community and hospital pharmacists.” Professor O’Mahony also features as this month’s interview profile. You can turn to page 9 for more coverage of his thoughts on this topical subject.
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This issue carries an in-depth look at Ireland’s generics market, with commentary from leading generics manufacturers and industry professionals whilst our clinical features examine the baby and infant market, as well as current management overviews of Type 1 diabetes and bladder weakness.
16 Irish Pharmacy IRISH News is PHARMACY circulated to all NEWS independent, multiple Pharmacists and academics in Ireland. All rights reserved by Irish Pharmacy News. All material published in Irish Pharmacy News is copyright and no part of this magazine may be reproduced, stored in a retrieval system or transmitted in any form without written permission. IPN Communications Ltd. has taken every care in compiling the magazine to ensure that it is correct at the time of going to press, however the publishers assume no responsibility for any effects from omissions or errors.
Elsewhere we also launch the 2019 Irish Pharmacy Awards. This is the eighth year of the Awards and entries are now being sought across 15 categories recognising best practice and excellence across community pharmacy professionals and their teams. Turn to page 49 for all the details.
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Falsified Medicines Directive comes into force After much discussion, debate, concern and worry, a new national and European system, giving patients further protection from the threat of counterfeit medicines came into effect last month.
Throughout Europe, medicine packs will have enhanced tamperproof measures and will now carry a barcode with a unique serial number so that each pack can be scanned in a pharmacy. It will be checked against a central database to ensure the product is legitimate before handover to a patient. Established and managed by the Irish Medicines Verification Organisation (IMVO), the new national system provides an additional layer of security to protect the supply of medicines at pharmacy and patient level. Ireland is now in compliance with the EU Falsified Medicines
Directive (FMD), which provides more safeguards and security to ensure Irish patients will continue to have absolute confidence in the medicines they receive from their pharmacy. According to Professor Pat O’Mahony, Chair, IMVO, “Setting up this advanced and robust verification system is a significant undertaking as a result of over three years of collaboration by the key Irish stakeholders including pharmaceutical manufacturers, parallel distributors, wholesalers as well as community and hospital pharmacists. Substantial work
Pictured scanning the first medicine in Ireland under new legislation to further protect patients from the threat of counterfeit medicines, at Conefrey's Care Plus pharmacy, Pearse Street, were Leonie Clarke, General Manager, IMVO with Tomas Conefrey, Pharmacist (Photo: Fennell Photography)
The Registrar of the Pharmaceutical Society of Ireland (PSI), Niall Byrne, in his capacity as Returning Officer, is inviting nominations from pharmacists on the PSI Register of Pharmacists, who may wish to stand for election for appointment to the PSI Council in 2019. Nominations must be submitted to the PSI Returning Officer no later than 12 noon on Wednesday, 20 March 2019.
and investment has been required by everyone in the medicines supply chain to have the system up and running and in place as appropriate to the legislation coming into effect.
Ten vacancies will arise on the PSI Council on the 16 June 2019. Four of those vacancies are for pharmacist members of the Council.
“Although there has been no risk or reported incidents at pharmacy level from counterfeit or falsified medicines in Ireland, other countries have had issues so this new system provides further security and protection for Irish patients now and into the future. Counterfeit medicines can pose serious risks to health, as there is no guarantee of their quality or safety,” he says.
The PSI Council is the governing body (the board) of the PSI. The 21-member Council is made up a variety of people from different backgrounds. The Pharmacy Act provides that certain members of the Council are elected, others nominated by particular bodies, while others are appointed through the Public Appointments Service. However, each member is appointed by the Minister for Health to act in the interest of patients and the public in the promotion of safe, appropriate pharmacy care and services in Ireland.
Turn to page 9 for an in-depth interview with Professor O’Mahony and further details on the roll-out of FMD.
Industry recognised for ‘significant work’ At the Oireachtas Committee on Health recently, the Secretary General of the Department of Health, Jim Breslin, outlined the steps the health authorities, working with industry and other stakeholders, are taking to secure the supply of medicines to patients after Brexit. Jim Breslin, Secretary General, Department of Health the supply of medicines after the UK leaves the European Union on March 29th.
He called out the industry for “very significant work” undertaken in planning for Brexit, saying it had “well-developed supply chains”. The National Director of Acute Strategy and Planning at the HSE, John Hennessy, said preparations for Brexit had been multi-stakeholder, and planning was well advanced for continuity of
“The key supply chain challenges in the short or immediate term are likely to be related to medicines with a short shelf life, refrigerated supply chains, compounded products and time critical logistics,” said Mr Hennessy. The Government believes there are no immediate risks to the health of the population due to Brexit. IPHA recently took part in a Brexit Stakeholder Event, organised by the regulator, the HPRA, for manufacturers, distributors and marketing authorisation holders operating in Ireland or the UK.
Election For PSI Appointments
IPHA was represented by Loretto Callaghan, General Manager of Novartis, who leads the IPHA Brexit Project Group. Bernard Mallee, IPHA’s Director of Communications and Advocacy, said, “Risks to the continued supply of medicines after Brexit can never be fully discounted. But, crucially, they can be managed. That’s what pharmaceutical innovators have been spending time and money doing. Companies have made complex logistical and supply chain arrangements, including in some cases re-routing transport away from the UK. “Whatever the outcome of the turbulent politics of Brexit, there is a need for unity of purpose when it comes to preparing for the practical implications of the UK’s decision to leave the European Union.”
The 2019 election for the appointment of pharmacist members to PSI Council is being conducted in accordance with the PSI (Council) Rules 2008 and 2015. If you are interested in seeking appointment as a pharmacist member to the PSI Council, or for further information, visit www.thepsi.ie The positions arising for pharmacist members are those currently held by Council members Mary Rose Burke, Joanne Kissane, Muireann Ni Shuilleabháin and Rory O’Donnell. Their terms in office on the Council end on 16 June 2019. The filling of six vacancies for non-pharmacist members of Council is managed by the Department of Health and Public Appointments Service, as appropriate, with nominations to be sought from the Schools of Pharmacy and the HSE in 2019.
News Regulated Professions Bill Last month saw the publication of the Regulated Professions (Health and Social Care) (Amendment) Bill 2019. The Bill, which has been approved by Cabinet, amends the five health professional regulatory Acts, in particular in relation to fitness to practise and registration. The key amendments include: • Applicants for registration must declare on application, and annually thereafter, any convictions, or sanctions imposed on their practise by a regulatory body (inside or outside the State); • Disciplinary inquiries in other jurisdictions can be used as admissible evidence in fitness to practise proceedings in Ireland; • All sanctions will be published to ensure the public has access to information about disciplinary sanctions imposed on doctors, nurses, midwives, pharmacists and other regulated health professionals; • Practitioners will have the right to appeal to the High Court when minor sanctions of advice, admonishment or a censure in writing have been imposed on a practitioner. Currently there is no right of appeal for these sanctions. The five acts are the Dentists Act 1985, the Health and Social Care Professionals Act 2005; the Pharmacy Act 2007; the Medical Practitioners Act 2007; and the Nurses and Midwives Act 2011. Minister Harris said “This is an important piece of legislation both for the public and for health professionals. It will offer patients reassurance knowing they have information about all sanctions imposed on health professionals they are seeing, while also giving health professionals the right to appeal minor sanctions. “I look forward to progressing this important piece of legislation to ensure the regulation of our health care professions is as robust as possible. This is good for the profession and for the patient.” A number of other amendments will be made to speed up the fitness to practise process for medical practitioners, nurses and midwives.
Is medicines pricing ‘predatory’? The Irish Pharmaceutical Healthcare Association (IPHA), which represents pharmaceutical innovators, has rejected a claim made this month by the National Centre for Pharmoeconomics (NCPE) that medicines pricing is ‘predatory’, saying that it amounts to a charge of illegality against the industry. Professor Michael Barry, Clinical Director, National Centre for Pharmoeconomics
The NCPE is the body that advises the Health Service Executive (HSE) on the cost-effectiveness of medicines. Oliver O’Connor, CEO of IPHA, said the NCPE had accused the industry of “predatory” pricing. He was reacting to a statement by Professor Michael Barry, Clinical Director of the NCPE, in a radio interview. “That is an accusation of illegality which our industry utterly rejects. It is not acceptable for the NCPE, a State agency, to level an accusation of that import against our industry, especially when it is without foundation. The State knows the significance of our industry - 30,000 jobs, enormous investment in manufacturing and research, and a positive impact on healthcare outcomes for patients with serious illnesses. We have worked closely with the State on Brexit preparations, acknowledged by the Tánaiste just last week. And, yet, the NCPE, another arm of the State, is accusing the industry of illegality. Apart from the claim having no foundation, it is irresponsible,” said Mr O’Connor. “We do not have higher prices than the average of these other countries. As part of our deal with the State on pricing and supply, we have delivered hundreds of millions of euro in savings through
discounts and rebates - yet speed of access to innovative medicines remains among the worst in Europe. This is deeply unfair to patients,” said Mr O’Connor. In October last year, IPHA analysed the reimbursement dates in 14 of the nominated EU States (the ‘basket of 14’) for 18 products which had been reimbursed or at least discussed by the HSE Drugs Group that year. The analysis found that, on average, the products were available in 12.3 out of the 14 countries. The wait time to reimbursement was two-anda-half times the average of other western European countries. “There is no justification for denying access to some innovative medicines for patients in Ireland
when their western European peers can get them, especially when prices here are no higher than the average of the ‘basket of 14’ in other reference countries. At the same time, our industry is investing billions globally on the development of new medicines. “As we approach Rare Disease Day, we have urged policymakers to set a simple policy goal: to place Ireland in the top seven countries in the EU28 for speed of access to new medicines. Without laying down a marker like this, nothing will really change. We believe a better way can be found, with industry and Government working together towards a specific goal to drive change. We have a lot of catching up to do. This is urgent,” said Mr O‘Connor.
9th All Ireland Pharmacy Conference The 9th All Ireland Pharmacy conference will take place from 14th-15th October, 2019 in the Ballymascanlon Hotel. This conference is jointly coordinated by the Northern Ireland Centre for Pharmacy Learning and Development and the Irish Institute of Pharmacy. Its focus is to share good practice in pharmaceutical care and practice development across the primary and secondary care sectors. Pharmacists, technicians and qualified assistants will be
encouraged to exchange ideas for pharmaceutical service development in the Republic of Ireland and Northern Ireland. The conference is themed around the FIP Pharmaceutical Workforce Development Goals. Abstracts are invited that deal with a broad range of pharmacy practice, including (but not limited to) the following areas:
• Competency development (FIP Goal 5) • Advanced practice & specialisation (FIP Goal 4) • Workforce impact (FIP Goal 11) • Working with others (FIP Goal 8) Abstracts can be submitted via the IIOP website at www.iiop.ie
Future of Pharmacy being ‘undermined’ The Government’s failure to deliver on its promise to expand the role of community pharmacies has the potential to undermine their future, according to the Irish Pharmacy Union (IPU). As Irish Pharmacy News was going to press, new research was released on behalf of the IPU by Behaviour & Attitudes entitled – Perspectives of Community Pharmacy. The research has led to claims that if the Government does not follow through with its commitments it will have serious implications for the public in the medium term, as community pharmacies will face an uphill battle to attract newly qualified pharmacists.
this is the most accessed part of our health system. There are currently over 2,200 pharmacists working in community pharmacy supporting over 78 million patient interactions each year. Ensuring we have a continuing supply of newly qualified and enthusiastic pharmacists entering the profession is essential to continue to serve the needs of the Irish public. It is extremely worryingly, therefore, that just a third of all pharmacists say they would recommend community pharmacy to a student today.
Attitudes to Community Pharmacy Scale of Issues
Perspectives of Community
We have issued dozens of submissions and run numerous pilot studies in recent years but, in return, we receive no progress or updates. “If we do not allow young pharmacists to properly use their extensive knowledge and skills to better serve the public and patients’ needs, we will struggle to entice new recruits. This could have severe impacts on the future of pharmacy services and primary healthcare in Ireland. Unfortunately, that does not seem to concern the policymakers.”
Irish pharmacy study ranks in Top 50 The QS World University Rankings by Subject have been released, with some Irish universities managing to break into the top 50 in the world. And pharmacy features highly within the subject rankings. Trinity College Dublin has been ranked in the top 50 global universities for six subjects, and in the top 100, for a further 14 subjects. Overall Trinity has been ranked No.1 in Ireland in 29 subjects, underlining the strength and depth of the University’s research across a wide range of disciplines.
“Many perceive that the
The University’s top 50 subjects Pharmacy, which investigates Mr Connolly lamented that, failing to moved on to quantify perspectives ing canvassed spontaneouspharmacist views,career theisstudy ofand Ancient include Classics attitudes on becoming despite producing some of the evolve in Ireland in contrast to History ranked in a phenomenal remaining community most qualified pharmacists in countries, such as the UKwithin the qualitative phase. 13th place The worldwide, English udesand and views hadother been revealed pharmacists, found thatthat Irish the world, our system is content where pharmacists are permitted Language and Literature in pharmacists regard helping to consign them to a career of to provide a much wider range 28th place,give Mineral and Mining and the publicand as theinsights administration, meaningless oringpatients of findings across the two phases is reassuring, but does of healthcare services, including Engineering in 39th place, most satisfying part of their job. paperwork and excessive a Minor Ailment Scheme and a Nursing in 41st place, Performing However, too much cause red tape for concern. bureaucracy. He concluded by to considerable New Medicine Service. In recent Arts in 42nd place, Pharmacy and a lack of progress towards calling on the Government to evolution of the pharmacist role was the biggest drawback to attracting graduates to community pharmacy and retaining pharmacists in their current roles. 98% of pharmacists stated they spend too much time on paperwork, while 87% feel the profession’s role needs to be broadened.
years, we have made numerous submissions to the Department of Health with a view to providing more services to patients and have failed to gain meaningful engagement or progress.
IPU President Daragh Connolly said, “With 81% of adults in Ireland visiting a community pharmacy at least once a month,
lack of imagination. The approach is completely at odds with the stated objective of community based primary care services.
seize the opportunity to enhance primary care that community pharmacies provide and for the Regulators to assess the level of bureaucracy foisted on community pharmacists. Doing so, he said, will help patients and also demonstrate a commitment to would-be community pharmacists that their role is one that does matter and is a key cog in the healthcare chain.
and Pharmacology in 50th place.
ost all pharmacists feel that community pharmacy involves too much It has also been ranked in the top 100 for four broad subject & Humanities in 50th umentation and paperwork, with almost 19 out of 20 feeling that areas: theArtsPSI’s place globally; Engineering & 88th place; Life gations place a very heavy“We burden on community pharmacy. Again 19Technology out ofin20 Sciences & Medicine in 89th are now beyond frustrated and Social Sciences and at the apathetic approach to gest that community pharmacy is verybeing hard work nowadays, while place; a similar Management 89th. community pharmacies exhibited by the Government, University College Dublin (UCD) portion feelabout it has become acombining very underfunding stressfulandoccupation. a Speaking the results, achieved a higher number of Turn to page 25 for an in-depth look at Perspectives in Community Pharmacy.
subjects in the latest rankings, totalling 39. The highest-ranked subject was veterinary science in 26th place, followed by library and information management (38th), nursing (44th), English language and literature (49th), mineral and mining engineering (50th) and sports-related subjects (50th). The QS 2019 Subject Rankings are compiled based on a review of 1,200 universities from 78 locations. Universities are scored according to academic reputation, employer reputation and research impact (citations). The importance of academic reputation to these rankings is paramount, and Trinity’s consistently strong performance across a range of subjects clearly demonstrates the high regard in which the University’s researchers are held around the globe.
Talking New Directions with IMVO Chair
f I were to ask our readers, “who hasn’t heard of the Falsified Medicines Directive?” I am confident there would be no counting to be done. But what of the body working behind the scenes to ensure that the national system was in place prior to the February 9th deadline? The organisation who will manage the Irish medicines verification system going forward? The Irish Medicines Verification Organisation (IMVO) is a notfor-profit organisation that has been established by a range of stakeholders across the medicines supply chain in Ireland (pharmaceutical manufacturers, parallel distributors, wholesalers and community pharmacists) to set up and manage the Irish medicines verification system. Currently at the helm as invited Chair is Professor Pat O’Mahony, who took the time to explain to Irish Pharmacy News in greater detail how this new system will embed, and answers questions about community pharmacy’s readiness to embrace it. The Directive The new national and European system, giving patients further protection from the threat of counterfeit medicines came into effect last month (February 9th). Throughout Europe, medicine packs will have enhanced tamperproof measures and will now carry a barcode with a unique serial number so that each pack can be scanned in a pharmacy. It will be checked against a central database to ensure the product is legitimate before handover to a patient.
Established and managed by the Irish IMVO, the new national system provides an additional layer of security to protect the supply of medicines at pharmacy and patient level. Ireland is now in compliance with the EU Falsified Medicines Directive (FMD), which provides more safeguards and security to ensure Irish patients will continue to have absolute confidence in the medicines they receive from their pharmacy. IMVO has worked extensively over the last three years with the relevant State organisations to ensure a successful system is in place. This includes close collaboration with the Department of Health, the Health Products Regulatory Authority (HPRA), the Pharmaceutical Society of Ireland (PSI) and the Health Service Executive (HSE). There has also been extensive collaboration with the European Medicines Verification Organisation (EMVO) and other national medicines verification organisations to ensure that the system across Europe was ready for the 9th February deadline. Professor O’Mahony has been the Independent Chairperson since being invited by the Board to take up the position in June 2017. He
Professor Pat O'Mahony, Chair, Irish Medicines Verification Organisation
PHARMACYNEWSIRELAND.COM | 9
“Our key objectives were to have the national system ready on time and to have completed the processing of all applications for registration by 9th February. I am pleased to say that these objectives have been achieved”
has a long and varied experience in pharmaceutical regulation and public health through previous roles such as Chief Executive of the Health Products Regulatory Authority, Deputy Secretary General and Head of Governance and Performance at the Department of Health, and Chairman of the Management Board of the European Medicines Agency. In addition, he has been Chief Executive of Clinical Research Development Ireland (CRDI) since 2017 and last year was appointed as Chairperson of the board of the Health Information and Quality Authority (HIQA). In giving an overview as to the size of the problem of falsified medicines within Ireland to set the context, he says, “There are already extensive controls in place in Ireland and right across the European Union to prevent the spread of counterfeit and illegal packs of medicines. These controls involve manufacturers, wholesalers, retail pharmacists and organisations such as the Health Products Regulatory Authority (HPRA), Revenue’s customs service and An Garda
10 | PHARMACYNEWSIRELAND.COM
Síochána, aimed at detecting counterfeit products before they get to patients. “While, according to the HPRA, almost 90,000 dosage units of falsified and other illegal medicines bought over the Internet were detained coming into Ireland in 2018, to date, there are no reports of counterfeit or fake medicines at pharmacy level in Ireland.
with manufacturers as full equal partners in IMVO to have a say in the development of the system in Ireland,” he adds. The members of IMVO are: - Association of Pharmaceutical Parallel Distributors (www.aippd.ie) which represents active parallel importers in Ireland.
“This is not the case elsewhere however, and there have been reports of fake medicines coming through legitimate supply channels in other countries including the UK, so this risk cannot be ignored. So these new EU-wide measures are being introduced to tackle the threat posed by counterfeiters and to add an extra layer of protection into the existing, already robust supply channels.”
- Irish Pharmaceutical Healthcare Association (www.ipha.ie) which represents the international research-based pharmaceutical industry in Ireland.
The Role of IMVO
- Medicines for Ireland (www.medicinesforireland.ie) which represents Irish-based manufacturers and suppliers of generic, OTC, biosimilars and hybrid medicines.
“The background to IMVO is that pharmaceutical manufacturers are required under European law to set-up and fund for a not-forprofit organisation to manage each national database of product information. Community pharmacists and wholesalers have chosen to become involved
- Irish Pharmacy Union (www.ipu.ie) which is the representative and professional body for community pharmacists in Ireland.
- Pharmaceutical Distributors Federation Ireland which represents full-line pharmaceutical wholesalers.
Professor Pat O'Mahony, Chair, Irish Medicines Verification Organisation
The IMVS was fully ‘live’ during the pilot and the packs scanned were actual serialised packs that have been placed on the market in Ireland and distributed through wholesaler. At the time, it was envisaged to use the learnings from the pilot to fine-tune procedures and plan the full rampup phase of the project where IMVO start to onboard all the remaining end-users (pharmacies, wholesalers, hospitals) ahead of 9th February 2019. Professor O’Mahony explains further, “Our pilot started in May 2018 and we continued to collect information and feedback from pilot participants up until late last year. Thirty pharmacies, 4 wholesalers, 2 hospitals, 6 manufacturers and 6 providers of FMD software systems took part. “The objective of the pilot was to ensure that the national system functioned correctly with pharmacy, hospital and wholesalers’ FMD systems and that the IMVO procedures were working efficiently. The pilot generated a lot of useful learnings for IMVO, and resulted in changes to our onboarding procedures for pharmacies and associated training materials.
Professor O’Mahony continues, “IMVO is part of an EU-wide network of national medicines verification organisations, all operating national databases connected together via an EU Hub managed by the European Medicines Verification Organisation. This advanced and robust verification system captures the data of all medicines legitimately manufactured and supplied across Europe. “Our mission is to help protect Irish patients from falsified medicines. Our key objectives since being set up last year were to have the national system ready on time and to have completed the processing of all applications for registration received from community pharmacies, hospitals and wholesalers by 9th February. I am pleased to say that these objectives have been achieved.” Piloting Procedures During the summer of last year, IMVO ran a pilot of the Irish Medicines Verification System (IMVS) to ensure it functioned correctly with pharmacy and wholesalers systems and that associated IMVO procedures worked efficiently.
“Furthermore, it became clear from the pilot that the technical connection of end-users was complicated for people who are not IT professionals and we reached an agreement with the IT software providers that they would support their customers with this step. A key constraint on the pilot was that was there were relatively few serialised packs in the supply chain when it was taking place and while pilot participants reported that scanning was straightforward, it was not possible to gauge how scanning would work in practice for large numbers of packs on a daily basis.” The Irish Context So where does Ireland lie with regards to ‘readiness’ to embrace FMD in comparison to European counterparts? Professor O’Mahony reveals Ireland was one of the first of the national systems to go live in Europe, in April of last year. “All countries across Europe have now set up their national systems, with the exception of Italy and Greece who have an extended implementation period, as they have pre-existing national systems,” he says. “IMVO’s objective is to be one of the leading national medicines verification organisations in Europe
“IMVO’s objective is to be one of the leading national medicines verification organisations in Europe and to that end, we were very proud to be amongst the first of the national systems to go live in Europe last April” and to that end, we were very proud to be amongst the first of the national systems to go live in Europe last April. We have also been proactive in driving collaboration between the national organisations on joint projects and sharing of information and expertise and this has resulted in significant time and cost efficiencies for all of us. “Our primary objective at this point in time is to stabilise the system in Ireland, make sure all actors are connected to the system and are using the system in a consistent manner and to make sure that it continues to function without any technical problems. It has been decided by the Department of Health, HPRA and PSI to adopt a pragmatic approach to the implementation of the system in Ireland, to ensure the continuity of safe supply of medicines to patients while all parties gain a better understanding of the new system. This means that during the initial period of operation, the system will be considered to be in a ‘use and learn’ phase. “Therefore wholesalers, pharmacies and hospitals are required to scan medicines bearing the safety features and if an alert or any other unexpected message is flagged, they should continue to supply packs to patients in accordance with their existing procedures, unless they have overriding concerns that a falsified medicine is involved. The system will be reviewed again after three months of operation. A similar approach has been adopted by most countries in Europe.” Overcoming Obstacles Like any work in progress, there are always going to be challenges and obstacles. However Professor O’Mahony believes the correct systems have been put in place to ensure community pharmacists know where to turn for assistance. “Pharmacists have been provided with guidance on where to go for support if issues arise, for example, problems with scanners should be directed to the supplier of the scanner, issues with the FMD system to the system supplier, etc,” he explains. “IMVO received a large volume of queries from pharmacists over the last couple of months in connection with our registration process but these have now
reduced to a trickle as their pharmacies are being connected. Prior to the announcement of the ‘use and learn’ period, during which pharmacists will ignore alerts and supply packs, they were asking a lot of questions about what to do if alerts were generated. The ‘use and learn’ period will be used to fine-tune the process for management of alerts and clear guidance will be provided to pharmacists in due course. “In addition to installing FMD software, wholesalers have had a number of unique challenges to deal with resulting in several new processes relating to stock handling and customer classification, all of which must be highly controlled under GDP (Good Distribution Practice). “The most significant challenge is that they are obliged to decommission packs for certain groups of customers, including GPs, dentists, schools and prisons, and this has required the creation of a separate ‘picking’ process for these customers to incorporate the decommissioning scan. This obligation becomes even more complicated for cold chain products and/or products which are dispatched in large volumes at specific times of the year, such as flu vaccines. “Wholesalers have also had to adapt their returns processes in light of FMD as they are now obliged to verify all returns, and once we move out of the ‘use and learn’ phase, will have to reject those returns which have already been decommissioned at the pharmacy. Verification of packs is also mandatory for packs received from certain suppliers, depending on the product concerned. “FMD implementation has been a challenge for all stakeholders, but the fact that the vast majority of pharmacies are now connected confirms that independent pharmacies were not ‘lost’ in terms of being FMD ready. To the very small number who have not yet connected, my advice is to get organised to start scanning as quickly as possible. Help is available.” Most importantly, this new national system will provide more safeguards and security to ensure Irish patients will continue to have absolute confidence in the medicines they receive from their pharmacy.
PHARMACYNEWSIRELAND.COM | 11
Pragmatic approach to ensure safe supply The European Commission’s Delegated Regulation on safety features for medicinal products for human use came into operation across Europe from 9 February 2019. Delegated Regulation (EU) 2016/161 supplements the Falsified Medicines Directive 2011/62/EU by setting out detailed rules for the safety features appearing on the packaging of medicinal products for human use. These new requirements will help to enhance patient safety by protecting the pharmaceutical supply chain from infiltration by falsified (or counterfeit) medicines and introducing new rules to more rigorously regulate the supply chain.
continuity of safe supply of medicines to patients while all parties gain a better understanding of the new system. This means that: 1. All medicinal products released by MAH’s for the Irish Market after 9 February should bear the safety features as required i.e. a tamper proof seal and 2D barcode
Notwithstanding the significant work undertaken to date and given the complexities associated with setting up the medicines verification system impacting all stakeholders in the medicines supply chain across Europe, it is anticipated that the initial period of operation will identify issues as the new system comes into effect Europe-wide.
2. During the initial period of operation, the system will be considered to be in ‘use and learn’ phase. Therefore wholesalers, pharmacies and hospitals should scan medicines bearing the safety features and if an alert or any other unexpected message is flagged, should continue to supply packs to patients in accordance with their existing procedures, unless they have overriding concerns that a falsified medicine is involved.
Following discussions at a national and European level with stakeholder representatives, it has been decided to adopt a pragmatic approach to the implementation of the Delegated Regulation (and the associated statutory instrument) after the go live date, to ensure the
3. All alerts generated by the FMD system upon scanning a pack during this ‘use and learn’ phase will be forwarded by the system to the IMVO, the HPRA and the pharmaceutical companies so that they can be investigated and monitored.
4. Notwithstanding the above, if a pharmacist or wholesaler has reason to believe that packaging has been interfered with, based on their examination of the antitampering device on the pack, they must report their concern to the HPRA (as a suspected quality defect via the usual reporting mechanisms) and not supply the pack. National legislation including the provisions of Article 23 of the Delegated Regulation will be introduced, however, the offences provided for in the Regulations will not be commenced for a period of time to let the new system bed in. During this period, the alerts generated will be analysed by the Department of Health, IMVO, HPRA, PSI, HSE and private hospitals pharmacies to determine why they are occurring and develop appropriate protocols for their resolution. Manufacturers (and marketing authorisation holders) will also be involved in the investigation of alerts generated against their products. The system will be reviewed again in three months’ time.
Allcare Pharmacies supporting communities From boxing and cricket to camogie and football, Allcare Pharmacies are supporting their community sports clubs with the help of FIXXA First Aid. Recipients of Allcare pharmacies donations, Skerries Harps GAA
precious minutes will be lost during crucial team training sessions and matches.
Much like these clubs, Allcare Pharmacies are central in their communities and FIXXA First Aid is proud to be involved in this community support initiative.
The local Allcare Pharmacies are gifting training bibs along with fully-stocked FIXXA First Aid bags to assist with any bumps and bruises and to make sure no
Recipients of the donations thus far include clubs across a range of sports including boxing, cricket, camogie and football. Among them were Skerries Harps GAA, Ardee Boxing Club, Saint Maurs GAA and Shrewleen Special Olympics Club.
Patterns of skin cancer studied A new study has analysed the pattern of skin cancer rates in kidney transplant patients, which suggests the increased risk is related to the anti-rejection medications. Led by researchers at the Royal College of Surgeons in Ireland (RCSI), the research was a collaboration between the National Cancer Registry Ireland and the National Kidney Transplant Service in Beaumont Hospital. Patients who receive a kidney transplant are at increased risk of cancer, in particular skin cancer. The study found that this skin cancer risk falls when the transplant fails and the patients return to dialysis but rises again when they receive another transplant. However, the rate of skin cancer is still higher in patients with failed transplants than pre-transplant patients on dialysis. “In recipients of multiple kidney transplants, the incidence of nonmelanoma skin cancer fell during periods defined by transplant failure, but there was still an elevated risk. The incidence of cancer overall highlights the need for continued cancer surveillance during graft failure,” said the study’s lead author Dr Donal Sexton, Department of Nephrology and Kidney Transplantation, Beaumont Hospital, RCSI. The study analysed the rates of cancer in 3,821 individual deceased and living kidney transplant recipients. Of the patients analysed, 3,215 recipients had one transplant, 522 recipients a second; and 84 recipients had three kidney transplants. During the patient’s first kidney transplant, the rate of skin cancer rose 15 times higher than before the procedure. That skin cancer rate fell by half when the transplant failed and the patient returned to dialysis; however, the rate was still seven times higher than the pre-transplant patient’s rate. When they received a second transplant, the rate of skin cancer rose again to 12.8 times more than pre-transplant rate.
DONâ€™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.
Welcome for VAT delay on supplements Pharmacists have been welcoming the decision by the Revenue Commissioners to delay the imposition of VAT on food supplements. Tina Tynan and Jacinta Tyndall from Horan's Health Store in Killarney. Photo: Michelle Crean/ Killarney Advertiser
changes to provide an opportunity for a wider consultation. The IPU looks forward to engaging, along with other stakeholder bodies, in the proposed consultation.”
For the last 40 years, the majority of food supplements supplied by pharmacies in Ireland, such as vitamins, minerals and fish oil products, have been exempt from VAT on the basis that they encourage the maintenance of health, through the sustenance derived from a normal, healthy diet. Pharmacists were concerned that a significant price increase would impact all customers who use vitamins and minerals to supplement their health needs. There are some groups of the population who rely heavily on supplements such as pregnant women, babies, elderly and those whose immune and digestive systems have been compromised. It is believed the VAT will remain unchanged until 1 November, 2019. More than 60,000 people signed a petition urging the government not to follow through with the plans. A hashtag #stopthistax has even been trending on Twitter.
Welcoming the announcement, IPU Secretary General Darragh O’Loughlin said, “The threatened imposition of a VAT rate of 23% on various vitamins and food supplements had understandably led to a great deal of concern among the public. Applying 23% VAT across the board on all food supplements would negatively impact their affordability for less well-off people, the elderly, or those with ongoing health issues, who are trying to maintain their health. “Diet, exercise and food supplements have become important areas in supporting general wellbeing and introducing this additional cost would be an extra burden on people who require food supplements for health reasons and are taking them under the recommendation of a health professional. “We welcome the decision of the Revenue Commissioners to delay the implementation of these
Commercial Director of CarePlus Pharmacy, Niamh Lynch also welcomed the announcement. “At CarePlus, many of our customers purchase vitamins on the recommendation from their GPs and healthcare providers. For some consumers, the price escalation might be a barrier to maintaining good health and self-care. Efforts should be made to relieve an overburdened health system and not tax efforts to remain healthy. CarePlus will engage fully with any public consultation on behalf of our customers.” Retail Excellence, Ireland’s largest retail industry representative body also called on the Government to review the proposed VAT hike. Commenting, Group CEO of Retail Excellence, David Fitzsimons said, “Retail Excellence has been working on this with, and on behalf of our members across the country since we first became aware of the issue late last year. This move will have a huge knock-on effect for retailers, pharmacies and particularly small, independent, family run stores who have been the mainstay of high streets up and down the country for decades.”
National research ethics committee The Government has approved proposals to prepare a General Scheme of a Bill to provide for national research ethics committees. Innovation 2020, Ireland’s strategy for research and development, science and technology , aims to make Ireland a global leader in research and innovation and the Government is committed to the ongoing development of a quality focused researchactive health system in Ireland. That commitment has already seen major public investment in research infrastructure, personnel,
new skills and technology. Over the last decade, there has been more than ¤150 million Government funding invested in clinical research and clinical trials infrastructure through the Health Research Board (HRB) alone. There has also been significant investment from State bodies, like Science Foundation Ireland, voluntary organisations and the private sector.
The proposed new system will address concerns that have been raised by stakeholders over the last decade about the existing RECs system in Ireland for clinical trials and health research generally. This approach will maximise synergies and value-for-money outcomes and make Ireland a more attractive international location for all health research.
MSc in Clinical Pharmacy Applications are being invited for a two-year (part-time) distance learning Master’s Degree offered by the School of Pharmacy, University College Cork course, commencing in September 2019. The course is structured to provide specialist training to enable pharmacists working in community and hospital pharmacies, extend their professional role within the evolving clinical healthcare system. The course will develop 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. It will also provide graduates with 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 distance learning format allows students to remain in employment throughout the course. Students will be able to communicate with each other and the teaching staff by means of regular teleconferences/ webinars and interactive internet systems. Applicants must hold a primary pharmacy degree and ideally, should have a minimum of one year practical experience. Applicants must be registered as a pharmacist with the professional accreditation authority in the country in which they are practising. Closing date for applications is 30th June 2019. Applicants must apply online at www.pac.ie/ucc
National Patient Safety Learning Zone A number of updates have been made to the functionality of the NPSO Learning Zone to make it easier to navigate and access relevant learning content to support pharmacists in their role. All courses are now accessible directly through the homepage, so pharmacists no longer have to go through the catalogue page. The National Patient Safety Office plans to add new resources to the Learning Zone later this year.
Teva in Ireland Teva is one of the largest pharmaceutical companies in Ireland, with over 600 employees.
Teva’s commercial activities span the sales and support services for Teva’s large portfolio of medicines, both generics and branded innovative medicines, along with over-the-counter consumer health products.
We are the largest supplier of prescription medicines to Irish pharmacies. That’s around 13% of total packs of medicine in Ireland.2
We estimate that every day almost 1 million Teva medicines are taken by patients in Ireland.1
1 in 7
prescription packs supplied to Irish pharmacies is a Teva medicine.3
In Ireland, we supply the equivalent of one Teva pack every 3 seconds.4
Respiratory manufacturing plus R&D
Baldoyle, Dublin Manufacturing (Sudocrem®)
Baldoyle is a manufacturing site for the over-the-counter medication Sudocrem® Antiseptic Healing Cream.
invested over the last 10 years
It was first developed in 1931 and is now a multi-award winning, globally recognised product sold in over 50 countries. Sudocrem® is loved for its ability to heal nappy rash as well as cuts, grazes, bed sores, sunburn and eczema.
It is the top selling nappy rash product in 15 countries, and 34 million pots are sold worldwide every year.
in export sales over the last 5 years
of research and development and FDA approved pharmaceutical manufacturing
References: 1-4 Teva Ireland - Data on file
The respiratory medicines manufactured in Waterford are distributed to over
Date of preparation: February 2019
The Bottom Line on Generics in Ireland The use of pharmaceutical generics can increase cost-effectiveness and efficiency in health care provision and spending. According to the recently published ‘Health in Ireland: Key Trends’ Report, the percent share of generics has more than doubled in Ireland since 2008, while the OECD average has increased by 36.6% in the same period. However, Ireland is still significantly below other OECD countries for use of generics. Generic substitution was introduced by the Health Service here in 2013, with the usage of these medicines growing
from 11% to 53% in the first four years thereafter. Generic drugs made up over 60% of the total off-patent medicines market in Ireland by the end of 2014. Many within the industry have been vocal about reform being essential, to maintain this momentum, warning that medicine costs for the HSE and patients will continue to increase over the period ahead unless further reforms are prioritised. Key achievements derived from generic substitution over the period have included:
Failure of the Irish Government to agree a National Pricing Agreement with the generics industry sends a message that the uptake of generic medicines is not a priority Jeffrey Walsh, Head of Sales, Pinewood Healthcare
• ¤1.6 billion in savings delivered to the Irish State since 2013 • The average wholesale price per pack of medicines has fallen from ¤18 in 2012 to ¤6 by 2018 • For example, overall spend on Ireland’s most used medicine, statins, used to lower cholesterol, has fallen from ¤160 million to ¤36 million per annum Paul Neill, Associate Director with Teva Pharmaceuticals Ireland, says it’s important to remember where Ireland started from. “While Ireland’s use of generics has doubled since 2008 and of course this is very positive, we have to remember that Ireland was starting from an extremely low base,” says Mr Neill. “The 2013 Act helped to drive generic usage and the trajectory was upward for a number of years, this growth has plateaued over the last year or two. This leaves Ireland still way behind the best performers for generic
penetration in Europe. With just under 60% generic usage in the market here, contrasted with as high as 90% uptake in other EU States, it’s clear that there remains much yet to do. “In 2019, it feels like the reforming zeal of 2013 has been lost somewhat. However, against a background of increasing healthcare expenditure, an aging population and growing health service demands, the need to continue to drive generic uptake remains as important today as it was five years ago.” Jeffrey Walsh is Ireland Head of Sales with Pinewood Healthcare. He believes Governmental lack of priority is one of the leading reasons for Ireland’s lack of progress within this sector. “While there has been some progress in Ireland, we are still falling behind model countries such as the UK who have almost 90% generics use,” he told Irish Pharmacy News. “Failure of the Irish Government to agree a National Pricing Agreement with the generics industry sends a message that
Hi Tech Portfolio ANTI-BACTERIAL AGENT
600 mg x 10 Film Coated Tablets
30 MU/0.5 ml Solution for Injection / Infusion in Pre-Filled Syringe x 5
Voriconazole Accord Voriconazole
50 mg x 28 Film Coated Tablets 200 mg x 28 Film Coated Tablets
450 mg x 60 Film Coated Tablets
48 MU/0.5 ml Solution for Injection / Infusion in Pre-Filled Syringe x 5
Pelgraz ▼ Pegfilgrastim
6 mg Solution for Injection in Pre-Filled Syringe x1
PULMONARY ARTERIAL HYPERTENSION
20 mg x 90 Film Coated Tablets
Mycophenolate Mofetil Accord
Mycophenolate Mofetil 250 mg x 100 Capsules 500 mg x 50 Film Coated Tablets
HIV-1 INFECTION AND HEPATITIS B INFECTION
Tenofovir disoproxil Tenofovir disoproxil
245 mg x 30 Film Coated Tablets
HEPATITIS B INFECTION
Entecavir (Actavis) Entecavir
0.5 mg x 30 Film Coated Tablets
50 mg x 28 Film Coated Tablets
Capecitabine Accord Capecitabine
150 mg x 60 Film Coated Tablets 300 mg x 60 Film Coated Tablets 500 mg x 120 Film Coated Tablets
Imatinib Accord Imatinib
100 mg x 60 Film Coated Tablets 400 mg x 30 Film Coated Tablets
Temozolomide Accord Temozolomide
5 mg x 5 Hard Capsules 20 mg x 5 Hard Capsules 100 mg x 5 Hard Capsules 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
the uptake of generic medicines is not a priority. Although legislation is still only five years old, the Government cannot be complacent. We need to keep pushing increased genericisation including the use of biosimilars over biologics which are depressing the generic uptake numbers.” In order to counter this, encouragement of competition and a new National Pricing Agreement is key. “There needs to be dynamic market pricing that encourages competition and opens the market to multiple suppliers,” he continues. “This calls for a new National Pricing Agreement which sets ambitious targets for generic penetration that is on par with Europe’s best performing markets in addition to the publication and implementation of a National Biosimilar Policy.” According to Mr Neill, a lack of agreement between the generics industry here and the Department of Health makes no sense. “Currently there is no agreement between the generics industry here and the Department of Health. It makes no sense that that the Government does have an industry agreement in place with the representatives of minority suppliers (IPHA) but none with the generics industry, the largest suppliers of medicine to the State. It is sending the wrong message in terms of the priority that is placed on the use of procuring more affordable generic medicines and, ultimately, on increasing access to medicines for patients in Ireland.” However, the need for reform is ongoing. There are many areas of the market which remain untouched by reform
an all stakeholders need to remain focused on continuing to promote and use the most affordable but equally efficacious medicines, such as generics, adds Mr Neill.
is unsustainable over the longer-term. These low-cost medicines continue to be used by tens of thousands of Irish patients but are also often most vulnerable to shortages”.
“In my view, unless we have a constant focus on cost efficient prescribing and increasing generic penetration there will be a risk of a slow creep of medicine budget increases in the years ahead,” he says.
“This unsustainable pricing has made the Irish market unattractive to global suppliers, who have to factor in development, production, regulatory and staffing costs before supplying the market here.”
“I feel that there is now a need to look again at our medicine spend and introduce further reforms to ensure that payers do not slip into old habits of overdependence on more expensive originator medicines, whilst continuing to support generic usage.” Medicines Shortages Medicines shortages have become a growing feature of the Irish healthcare landscape in recent years, prompting bodies such as the HPRA to now move to develop solutions to the problem. However, industry groups such as Medicines for Ireland point out that the unsustainably low reimbursement price set by the HSE for many of these medicines is often a major driver for shortages. Many generic medicines are now priced so low as to render them unattractive to global suppliers, who direct these products away from Ireland to higher priced markets. Chair of Medicines for Ireland and Country Manager for Mylan, Owen McKeon adds, “Ireland has now reached a tipping point whereby the price of some generic medicines has fallen to such an extent that often a month’s supply can cost less than a bar of chocolate. This
The proposals indicated can transform medicine budgets by delivering immediate savings of significant magnitude, just as changes to generic medicines did in 2013. In doing so, taxpayers get better value, and the ability to fund newer innovative medicines is enhanced Martin Gallagher, Director of Sales & Business Development, Clonmel Healthcare
“Despite the fact that reference pricing and generic substitution has delivered over ¤1.2 billion in savings over the period of 2013 to 2018, Medicines for Ireland strongly feels that there is still more that the Government can do,” Mr McKeon continues. Savings Potential with Biosimilars
In the event of a hard Brexit, the risks are considerable. Many generic products on the Irish market are manufactured, packed or tested and released in the UK. Time is needed to resource these from within the EU Tony Hynds, Managing Director, Accord Healthcare Ireland
“This involves a new National Pricing Agreement which includes the generics industry and sets targets for generic penetration, a National Biosimilar Policy to increase biosimilar uptake and more responsive pricing in the market to drive competition.” Martin Gallagher, Director of Sales & Business Development at Clonmel Healthcare, believes that the Government are finally waking up to the potential savings that can be achieved from Biosimilars. He welcomed Professor Michael Barry’s plan, as outlined recently in the Sunday Business Post, to announce ‘in the coming weeks’ specific measures to move to better value biosimilar medicines. It is understood that the measures may include compulsory prescribing of better value biosimilar medicines over the more expensive, biologic alternatives. Professor Barry also signalled that consideration is
being given to making changes to the State reimbursement system which would require GPs and hospital consultants to justify their prescribing decisions if they choose to prescribe medicines which are more expensive than the better value biosimilar alternative. Each year the HSE spends over ¤280 million on the more expensive biologic medicines, despite more affordable biosimilars available on the Irish market. Biosimilar medicines represent only 6% of the total share of the market in Ireland, compared to as much as 90% in other EU States. “Professor Barry’s remarks, as published, are encouraging. If implemented, it would finally represent changes which we and others have long been calling for,” says Mr Galllagher.
About Bluefish Bluefish Ireland is committed to delivering a first class customer service experience with trust and integrity at the centre of everything we do. The Irish team have an abundance of experience in the industry and are committed to delivering on their commitments. We like to make doing business as simple as possible.
Leading the way to a healthier Future
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The opportunity for further growth in generic medicines is linked to all stakeholders working to unlock barriers to further generic uptake in the Irish market Paul Neill, Associate Director, Teva Pharmaceuticals Ireland
of Health. Pharmacists have clearly demonstrated that savings are available if steps are taken to address soaring spending on biological medicines but, despite concrete proposals being submitted in September 2017 by the IPU, no action has been taken. IPU Secretary General Darragh O’Loughlin says failure to implement this proposal is costing ¤2 million in potential savings every week. “If the Government had heeded IPU advice when we submitted the proposal last September, approximately ¤80 million could have been saved to date. The IPU is presenting solutions to budget problems, but Government continues to ignore potential savings. “Substituting expensive biological medicines with more cost-effective biosimilars would require a legislative change, but could save the Exchequer up to ¤800 million over 5 years,” said Mr O’Loughlin, who added “This is the fastest and most effective way to ensure a rapid and meaningful increase in the use of biosimilars.
“The proposals indicated can transform medicine budgets by delivering immediate savings of significant magnitude, just as changes to generic medicines did in 2013. In doing so, taxpayers get better value, and the ability to fund newer innovative medicines is enhanced.” Tony Hynds is Managing Director with Accord Healthcare Ireland. He told us, “Publication of the Biosimilar policy, assuming it advocates biosimilar prescribing or interchangability would make a significant reduction in government spending of ¤800 million over 5 years, according to the IPU.” In July of last year, The Irish Pharmacy Union (IPU) called on the Government to allow pharmacists to substitute biological medicines for biosimilars, to help plug overspending at the Department
“In the absence of specific steps being taken to improve biologic uptake, HSE spending on biologics is expected to reach ¤900 million by 2020. If this amendment is made, there are potential savings of ¤370 million over the next 3 years, and up to ¤800 million over 5 years. In 2017 the Department of Health held a public consultation on a National Biosimilar Medicines Policy, and the IPU made these proposals in our submission in September 2017. “The time to act on this is now, and we’re calling on Minister Harris to amend the Health (Pricing and Supply of Medical Goods) Act 2013 and allow pharmacists to substitute biological medicines with more cost-effective biosimilars”, adds Mr O’Loughlin. Mr Hynds also believes one of the key reasons Ireland is still behind other OECD countries lies with the Interchangeable list. “While the Interchangeable list includes over 70 molecules, there are remarkably few additions as new molecules lose patent protection. The list should be reviewed at least quarterly to enable pharmacists substitute newly patent expired products where generics are available,” he says.
“The Department of Health should request the HPRA assess newly patent expired molecules for inclusion in the interchangeable list post patent expiry.” Impact of Brexit In the event of a hard Brexit, Mr Hynds says the risks are considerable. He believes Brexit remains the biggest challenge to this market. “Many products on the Irish market are manufactured, packed or tested and released in the UK. Time is needed to change these activities to within the EU. In the event of a transition period being agreed, there will still be pressure on MA holders to make alternative arrangements to their supply chains to exclude the UK. “Also many products are pack shared with the UK and while the HPRA has indicated its willingness to support this arrangement post Brexit, the physical testing of stock for the Irish market will have to take place in the EU.” There are many unknowns at play, according to Teva’s Mr Neill. “However, what’s most important is the extent to which manufacturers, suppliers, healthcare providers and other relevant stakeholders now manage that risk,” he says. “At Teva, we have been working hard to identify and minimise any risks that Brexit poses within our portfolio, this includes ensuring that where necessary we have additional stocks of medicines supplies in Ireland. We have also developed alternative supply routes into Ireland to reduce dependency on the UK landbridge for the transportation of goods from mainland Europe.” And what of the existing opportunities for generics in Ireland? “This lies in negotiating a new National Pricing Agreement with the Department of Health which increases generic usage to ‘best practice’ levels within Europe,” continues Mr McKeon. “Equally, a biosimilar policy which sets ambitious targets on biosimilar usage. The challenge, as ever, lies in the risk posed by vested interests who continue to resist the movement to the increased usage of equally effective but more affordable generic medicines. As was the case for many years up to 2013, they will continue to resist change.”
Pinewood’s Mr Walsh says, “I hope (in the future) that it will be a mature medicines market with high levels of generic penetration where all stakeholders are fully attuned to the benefits of generics, particularly in terms of increasing patient access to life enhancing medicines and the opportunity they present to drive the affordability of such medicines for our patients and wider healthcare system.” The future according to Mr Neill lies in working together to unlock potential. “The opportunity for further growth in generic medicines is linked to all stakeholders working to unlock barriers to further generic uptake in the Irish market. Proactive measures such as a National Pricing Agreement, a dynamic, competitive market and a sensible approach to pricing which recognises that we need a sustainable price for medicines to ensure continuity of supply in the relatively small Irish market, are all critical to strengthening the position of generics in Ireland. “Notwithstanding these constraints, we are hugely optimistic about our capacity to increase our footprint in the Irish market in the years ahead,” he concludes.
Medicines for Ireland has set out a number of immediate reform proposals, which it estimates can deliver almost ¤140 million in savings per annum. These include: • A new National Medicine Pricing Agreement with the generics industry to drive further reforms; • Increasing competition in Ireland’s medicine market, particularly in the low-volume, low value medicines market, which would deliver at least ¤75 million in savings; • Immediate publication of a National Biosimilar Strategy, which was first promised in February 2017 and which has the potential to deliver ¤25 million in savings; • Changing existing legislation to provide all new patients with generic medicines would yield ¤18 million in savings; • Reform of the High-Tech Scheme to provide ¤20 million in savings.
IRL/N/0219/0020. Date of preparation: Feb 2019.
The quantitative study involved asking pharmacists to agree or disagree with a series of statements around the role of the community pharmacist. 25
A number of facets were almost universally endorsed, including that pharmacists spend too much time on paperwork (98%), that pharmacists and GPs need to work more closely together (95%), that the status of the pharmacist has been undermined The number of new community pharmacists is declining. in recent years (82%), and that the profession needs to lobby for a broadening of its 82% of community pharmacists are frustrated at red tape and increasing bureaucracy role (87%). No progress is currently being made on efforts to expand the role of community pharmacists
Government apathy threatening the future of pharmacy
These are just three startling statistics to arise from the recently published Perspectives of Community Pharmacy report carried out by Behaviour & Attitudes on behalf of the Irish Pharmacy Union (IPU). In this article, we take a closer look at some of the ‘Perspectives.’ The number of graduates opting to stay and work within community pharmacy after graduation has been in decline. This has happened at a time when the supply of graduates has actually increased, with the expansion of pharmacy faculties to three over the past decade. Anecdotally, there had been suggestion that pharmacy graduates had higher expectations and felt that community pharmacy couldn’t deliver upon these. Others speculated that the number of chains buying up existing independent pharmacies was a deterrent, while many felt that young pharmacists themselves couldn’t countenance the extent of debt required to borrow to ultimately purchase a pharmacy these days.
A concern remains that there is the UK, whereas such a shift first place. It is unlikely that These largely what was established and it was cohort of quitephase experienced, thereelements are many other careersmirror that is not allowed under existing in the aqualitative albeit non-owner, pharmacists are so widely chosen on regulation here. interesting the number of times that separate groups mentioned that the profession who seem quite weighed down by the basis of familial or other A substantial majority (88%) the responsibility and challenges trusted recommendation. is not well represented within thepatients Department Although there are feel that have becomeof Health. presented to them by their There is evidence that the status moreconsensus demanding seems day-to-day lives. the Theiroffice pharmacists in the Department,considerably the general to beworking that that of the profession is felt to have in recent years, undoubtedly younger contemporaries seem becomedon’t undermined, some, status contributing the stress andthe Chief more Medical upbeat, but Officer. nonetheless There holders haveforequal to, forto example, more recently. It is important to pressure experienced. 71% feel many of them are less inclined to juxtaposition two facets: within seems to be athese perspective profession that benefit that the community pharmacies arepharmacists want to ownwould a pharmacy and, infrom a career or occupation that no longer sufficiently profitable fact, some are less convinced wassenior held in high regard and more representation “atand the within of Health. thistop leadstable” a majority (81%) the Department that community pharmacy is
recommended, and one which what they should work in over the to feel that there needs to be a many in the sector now feel has longer term. placed upon the heightened focus on centralised Equally, there is a view that some form of constraint has been been undermined or debased buying, although the perspective Community pharmacy appears to by change and, for some, by a Influencing Factors freedom of the profession toofevolve andmembership broadenis its role. The marked contrast symbol group be at something of a crossroads, perceived inability of the role of more divided. The central objective of the study quite a despondent the pharmacist evolve to mirror the to breadth of the role of the pharmacist inwiththe UK and in and Ireland is was to understand the attitudes between resigned perspective apparent societal requirements (or as it has Concluding Thoughts of all those connected with amongst substantial proportion, been done referenced in other countries.) frequently and seems to be a particular bugbear. Theaperspective that the the sector towards becoming Right across the research albeit often out of the conviction Common Themes and remaining a community series closely it was difficult for more thatwas the profession won’t or can’t GP and the pharmacist don’t work enough together also referenced quite pharmacist. Fundamental to this established and older pharmacists evolve. It is clearly important Many perceive that the career was a requirement to identify the commonly in the qualitative phase and changes it was frequently commented that there needs to perceive occurring to return a sense of optimism is failing to evolve or change facets that drive and deter the which would beneficially impact and of the possibility for change in Ireland. By contrast, they appeal of working in community to be a more immediatetheir mechanism for to practising community pharmacies and business. parallel it with a sector which pharmacy at present. pharmacists, as much as By contrast, younger pharmacists has undergone considerable interacting with local GPs andwere reviewing patient it is to agitate for evolution much more enthusiastic change and evolution in the UK Family connection to the world that employees have and development in terms of about the possibility of change71% say and in as manyand other countries. of pharmacy and it being issues where Forpossible. Again some the actual role and scope of or indeed being prepared to no incentive to buy a pharmacy example, it is now commonplace recommended are among the contemporary Irish pharmacies. conceive that change might for there to be pharmacy-led was made to this being facilitated more most important basis for having reference clinics in many locations across be achievable. chosen to study pharmacy in the
82% community pharmacy needs to develop more services
directly and routinely in the UK than is the case in the Irish system.
72% - there are too many community Irish Pharmacy Union pharmacies
71% - community pharmacies are no longer sufficiently profitable
81% - there needs to be a heightened focus on centralised 27 27 buying
Sexual Health made priority by HSE The Health Service Executive has said there will be “targeted investment” in 2019 to ensure the provision of free condoms as part of funding for a number of additional recommendations made as part of the Oireachtas committee examination of the Eighth Amendment. The HSE will provide free condoms in colleges and among 'at risk' groups this year as the first step towards ensuring greater access to free contraception. The HSE and department will be conducting research in early 2019 to examine how best to develop a “sustainable distribution model” for building wider access to condoms outside of clinics. As part of this research, the HSE will determine which forms of contraceptives should be made freely available to women. The HSE is also set to carry out a new 'in-depth national survey' on sexual health and crisis pregnancy, the first of its kind since 2010. There will be sexual health promotion training for professionals in the youth sector, targeted outreach programmes and campaigns for at risk groups along with the promotion of sexual health and safer-sex public advertising, said the department spokeswoman. This will include the dissemination of information through the new sexualwellbeing.ie website launched earlier this year. Health Minister Simon Harris
said the additional funding for the new sexual health initiatives will “help us achieve our goals of reducing crisis pregnancies but also improving public health, and supporting sex and relationships education for young people.” “Sex education shouldn't stop at schools,” he said. “We have to ensure that parents and those working with young people can help them develop healthy relationships and make informed decisions which protect their health and wellbeing.” Meanwhile, CarePlus Pharmacy distributed thousands of free condoms during Valentine's Week, held last month, to help to promote a culture of safe sex in Ireland. Each of the chain's 60 pharmacies nationwide took part in "Sexual Health Awareness Week" from February 12th-19th. The free condoms were packaged with information on the importance of safe sex, and freely available from the counter without asking in each pharmacy. Figures from the Health Protection Surveillance Unit of the HSE show
that rates of chlamydia, herpes simplex and gonorrhea are on the rise. For example, people in the age group 15-24 accounted for 51% of all chlamydia cases reported. CarePlus Pharmacist, John Keane says, “The days of people being embarrassed about condoms in pharmacies are long gone, but the statistics show that many young people are not as careful as they should be. People should know that they can talk to their pharmacist, in privacy and confidentiality, about anything including their sexual health.” Condoms are currently considered to a ‘luxury’ item, and subject to the higher rate of VAT. Niamh Lynch, Commercial Director for CarePlus Pharmacy, hopes that will someday change. “Given the impact that STIs can have on people, it's clear that price should not be a barrier to safe sex,” she says. “If we can draw attention to the matter by distributing free condoms, hopefully it might give rise to a discussion about whether they are still a luxury item in 2019.”
Breathing Life into 13 new stores Life Pharmacy has added 13 new stores to its group in 2018, raising its national membership to 72. Buttevant Pharmacy Cork
“We took a huge step forward in 2018,” says Gerard Coffey, Chairman of Life Pharmacy. “With a growing membership, we’ve shown just how powerful we can be when we work together.”
The new members include Deasy’s Pharmacy, Cork (4); Lavelle’s Pharmacy, Mayo (2); Firgrove Pharmacy, Cork; Herlihy’s Pharmacy, Drogheda; Hogan’s
Pharmacy, Limerick; Buttevant Pharmacy, Cork;Feargal Leahy’s Pharmacy, Galway; Gannon’s Pharmacy, Limerick and Kevin Leahy’s Pharmacy, Galway.
As well as welcoming new members, Life also celebrated the 10th anniversary since Brennan’s Life Pharmacy in Donabate joined the group. Owner Jane Brennan marked the milestone with a customer appreciation event and a new fit-out, becoming one of the first pharmacies to adopt Life’s updated fresh and modern appearance.
Point of Care Testing Consultation The Health Information and Quality Authority (HIQA) has commenced a national public consultation on a Draft Health Technology Assessment of C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescribing for acute respiratory tract infections in primary care settings. Antimicrobial resistance is a significant threat to public health, and widely acknowledged to be associated with the excessive and inappropriate consumption of antibiotics. Most antibiotics are prescribed in primary care settings and frequently to treat respiratory tract infections, which account for approximately one quarter of primary care attendances. The objective of CRP POCT is to assist the clinician rule out serious bacterial infection, thereby supporting a decision not to prescribe an antibiotic to those who are unlikely to benefit from treatment. HIQA’s health technology assessment reviews the clinical and cost-effectiveness of CRP POCT. The assessment will inform a decision as to whether CRP POCT should be used to support antibiotic prescribing in primary care for patients presenting with symptoms of acute respiratory tract infection. The assessment also considers the organisational implications associated with introducing CRP POCT in primary care. The review concluded that the use of CRP POCT to inform antibiotic prescribing in primary care for acute respiratory tract infections leads to a significant reduction in antibiotic prescribing without 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.
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Infant Feeding - Advice and Options Ireland has one of the lowest breastfeeding rates in the world. Rates are increasing steadily but breastfeeding incidence declines steeply in the early weeks after birth. The Institute of Public Health in Ireland reported last year that breastfeeding rates in the Republic and Northern Ireland were slowly growing and that between 2006 and 2015 the percentage of women breastfeeding when discharged from hospital rose from 49% to 58%. Some 35% of babies in the State continue to receive breastmilk at three months, according to the HSE.
he National Maternity Strategy says that in addition to practical supports provided to mothers, such as support to continue breastfeeding on return to the workplace, a broader societal change is required in order to promote a more positive culture around breastfeeding. This should support women to feel confident about their choice to breastfeed. In essence this means that all mothers should be supported to breastfeed at anytime and anywhere. The National Strategy for Women and Girls 2017-2020 re-affirmed the commitment to advance public support of breastfeeding, and includes an action to extend provision for breastfeeding breaks
under employment legislation (currently available to mothers of children under 6 months). However breastfeeding is frequently not a viable option for all. Some of the main reasons given for not continuing to breastfeed following the first few days and weeks include insufficient milk supply; fatigue; difficulty with breastfeeding technique; nipple pain and poor latch; lack of freedom; return to work; not wanting to breastfeed and embarrassment as a result of negative societal attitudes towards breastfeeding. Parents welcome the advice of healthcare professionals for infant feeding and the community pharmacy will be the first call when looking for guidance. In
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this article we look at the latest guidance and ask how you can grow your share of this important category. Baby Feeding Market Baby food continues to experience growth in value and volume terms, with growth expected to continue into the forecast period, according to the latest Euromonitor report. Parents are trading up and seeking baby food that has a higher nutritional content. Prepared baby food is the most dynamic category. Its growth comes from continues quality improvements and an alignment with current health and wellness trends. Research has also shown that convenience is paramount for many Irish consumers.
Another key characteristic of the global infant nutrition market is the very low penetration of supermarket private labels, at less than 1%, according to Zenith Global. This underlines the high degree of brand loyalty and the opportunities for higher profit margins. High quality and safety credentials are primary criteria for consumers and branded items are more strongly associated with these features. In many food categories, private label products compete successfully on price against brands. It appears, however, that the last item on which consumers seem to economise is baby food. Higher prices are justified by the perceived better nutritional value for babies from high quality branded products.
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It has been said, that there is a belief among pharmacists that much of their baby feeding sales have been lost to grocery, but others think that taking a different approach can make you a centre for feeding advice and win back sales. Pharmacists and their teams are ideally placed to provide advice and support to mothers when it comes to infant feeding. From giving practical tips and support on breastfeeding to identifying and advising on potential problems, the pharmacy team can make a real difference to young families in those early months. Many community pharmacists have not realised the full extent of the opportunities that exist for them to provide an advice service in their local communities. The National Childbirth Trust says women can experience unacceptable levels of pressure however they feed their babies from family and friends, as well as from people they hardly know. Mothers who breastfeed their babies often feel pressurised and constrained about whether, where, how often, and how long they breastfeed. Similarly, mothers who use formula milk often feel judged or guilty too, particularly, but not only - if they planned to breastfeed. Informed choice must be promoted, many maternity and infant experts advise. Formula Feeding The rapid growth of dairy farming in Ireland has led to its position as one of the leading global exporters of infant milk formula. There is a range of infant formulas available over-the-counter and either a whey or casein based formula is a suitable choice for infants from birth to the age of 12 months. Follow-on formulas, which contain more iron and vitamin D than ordinary formulas, are available for infants over the age of six months. Cows' milk is not suitable as a main drink for children under the age of 12 months. It contains little iron and vitamin D and may lead to intestinal blood loss in some children. Skimmed and semiskimmed milks should not be
used in infancy because of their low energy content. Semi-skimmed milk may be used from the age of 2 years where it is the milk used in the household and the infant's diet is varied. However, skimmed milk should not be used under the age of 5 years. Fruit juice is not necessary, but helps the absorption of iron from fruit, vegetables and cereals. It is important to remember that many parents do not receive instruction on appropriate technique for making up bottles; if formula preparation is not done properly, the baby may be at risk of dehydration and over or under-nutrition. Parents who bottle-feed can feel that they are not given enough impartial information about formula milks. Recent position statements recommended that balanced and relevant information is given to parents choosing to formula feed their babies, whether exclusively or partially, to enable them to do so safely and with support to encourage good bonding. This includes instructions on cleaning and sterilising equipment and the correct method for making up formula feeds. Pharmacy teams should know the differences between the different types of milks, as this can be bewildering for new parents. While leaflets on bottle feeding are essential, so are one-to-one discussions. Pharmacists must make sure customers understand about good hygiene, washing, sterilising and making up feeds. Signpost to other healthcare professionals if customers need extra help. Whey Based Formulae - The first group are whey based formulae. These are similar to breastmilk because the protein content is made up of more whey than casein. However, the total protein content of infant formulae is higher than breastmilk and as a result, infant formulae are not as digestible as breastmilk. These formulae are the most suitable for newborn and older infants. Casein Based Formulae - The second group are casein based formulae. Babies fed casein based formulae may have to work harder to digest each feed. This means
that baby may sleep more - All babies need time every day to be awake and alert, in order for them to grow and develop. "Follow-on" Milks – These are made from modified cow's milk with extra iron and vitamins. Soya Based Formulae - Soya based formulae and other specialised formulae should not be used without the advice of a dietician or doctor. All infant formulae on the Irish market must conform to the same EU standards and provide the same nutritional value. There should be no reason to change a baby from one "type" of formula to another. Specialist Formula Specialist infant formula is one area where pharmacists could provide a valuable service to those mothers who are unable to breastfeed and whose babies have an intolerance or a sensitivity to regular formula milk, or for those women whose baby has a problem such as reflux, colic or constipation. Many pharmacies can benefit from adopting a merchandising approach, with clear signposting to ‘Ask the pharmacist for advice.’ There has been an increase in the number of babies who do not thrive on standard formulas, which is why much of the growth in the infant formula market over the past year has been driven by an increase in purchases of specialist milks, aimed at addressing feeding problems. This offers a genuine opportunity for pharmacists because such products sit well with the pharmacy’s role as a provider of healthcare advice and remedies. By stocking one or two of these products, the pharmacy would be in a position to provide a possible solution. Hence it is vitally important all pharmacy staff understand the difference between formula types. It is important to stock some alternatives. Some parents may experience various feeding problems with their baby such as reflux, lactose intolerance or allergies. Make sure mums know they can get these specialist formulas on prescription if their baby has a diagnosis, so it’s also important they see their GP.
Baby Food Natural Alternatives One of the main trends driving growth in the baby food sector is a continued interest in natural and organic baby and childspecific products, reflecting higher awareness of ingredients such as parabens. With environmental conditions deteriorating globally, there is a rising anxiety as to the safety of the products we use and, even more so, the food we consume. There is a growing trend towards organic products, which stems from a concern for our health and general wellbeing and, even more so, that of our children. Organic baby products, food in particular, have therefore garnered much attention in recent years. Organic baby food has witnessed rapid adoption due to factors such as rise in parental concerns over baby’s nutrition, growing awareness about the benefits of organic products, improved distribution channels, and ecofriendly farming techniques. Link Sales New parents tend to seek out baby products that help to make their lives easier. Well-stocked shelves will ensure footfall, and encourage cross-category purchases, ensuring the pharmacy is a chosen destination for future family healthcare purchases. There is a great opportunity to have a strong “best for baby” message. Whether online or instore, pharmacies have that great position of trust. More so in the early years, when information and advice for new parents can feel overwhelming and confusing, community pharmacies have an essential role in offering advice and education on lifestyle issues and product selections, which will encourage a drive to the pharmacy instead of the GP or supermarket. The infant feeding market prospects are strong, proving recession-proof, despite falling birth rates. Nevertheless, the industry is dealing with a highly sensitive consumer. The importance of safety cannot be underestimated. Consumer confidence is key.
Table One: Milk for Infants 0-6 months
After 12 months
Breast or infant Formula
Whole cows’ milk
Semi-skimmed or skimmed milk
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Focus on Newborn and Child Health Baby care and child-specific products have an important role to play in pharmacy particularly in Ireland as birth rates here are currently higher than the EU average.
he birth rate in Ireland remains relatively high this year with 14.4 babies born per 1,000 residents compared to an average of 10.1 in the rest of the EU. Although the birth rate in Ireland peaked at almost 17 births per 1,000 people in 2009, and has declined since, the baby category has remained a highly lucrative one for Irish pharmacists and retailers alike. Health in Pregnancy Pregnancy can be a time of great excitement, but it can also come with great worry. Conflicting advice on how they should manage their own health and that of their unborn baby can leave many expectant mothers confused or even fearful about the months ahead.
• Lifestyle advice, including smoking cessation, and the implications of recreational drug use and alcohol consumption in pregnancy. Expectant mothers should be reassured that it is not necessary to invest in expensive multivitamin supplements, and that eating a good balanced diet during pregnancy, along with folic acid and vitamin D supplements, should be all that is required to ensure the best possible health outcomes for both themselves and their unborn child.
that that the body engineers this vulnerability deliberately, allowing beneficial microbes to colonise the baby’s gut, skin, mouth and lungs. Learning to manipulate this system could lead to treatments for infections in newborns, and perhaps even improve the way babies are vaccinated. During the last three month of pregnancy, antibodies from the mother are passed to the unborn baby through the placenta. This type of immunity is called passive immunity because the baby has been given antibodies rather than making them itself.
According to recent guidelines, community pharmacists and allied healthcare professionals should focus on the following during any first contact with a woman in the early stages of pregnancy:
Many pregnant women will suffer from heartburn. To treat heartburn, a common painful pregnancy ailment, both antacids and alginates are considered safe to use during pregnancy provided the recommended doses are adhered to. Pregnant women on iron supplements should be cautioned that antacids could prevent proper iron absorption, so should be taken at least two hours before or after the iron supplement.
• Folic acid supplementation
• Food hygiene, including how to reduce the risk of food-acquired infection
Newborn babies are very susceptible to bacterial infections with recent studies suggesting
Colic is one of the more stressful health issues for a parent to deal with. Colic is generally defined
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Immunity in newborn babies is only temporary and starts to decrease after the first few weeks or months. There are many different types of illnesses parents can seek help with from a pharmacist including colic, teething, constipation, temperatures, flu-like symptoms, and more minor afflictions including cradle cap and nappy rash.
as repeated, excessive bouts of crying. According to the HSE, recent estimates suggest that one in five babies are affected by colic and babies of both sexes are equally affected. The symptoms of colic usually begin within the first few weeks of life but just because it is a common affliction does not make it any easier for parents who cope with it every day. When a parent presents in a pharmacy with a colicky baby there are a number of ways a pharmacist can advise to help ease the situation. Warm baths, keeping the baby upright after feeds, frequent winding, osteopathy or homeopathy may offer some solutions but it is also important to tell the parents that they should seek support if they are feeling under stress while dealing with their colicky baby. Some OTC medications can work to help soothe the baby but generally there are not many treatment options for the problem.
t i f o r p Driving our in y store
CaldeSpray from the makers of Caldesene. Products for supply through general sales. A copy of the SmPC for Caldesene and Caldease is available on request.Clonmel Healthcare Ltd., Clonmel, Co. Tipperary. For topical use only. Cleanse and dry the area before applying. ALWAYS READ THE LABEL. Caldespray contains Zinc oxide 10%, 100ml pack size. The active ingredient in Caldesene Medicated Powder is Calcium Undecylenate 10% w/w 20g, 55g, 100g pack size. The active ingredient in Caldease Medicated Ointment is Zinc oxide 15% w/w 30g pack size. Date prepared: August 2017. 2017/ADV/CAL/038
8. Use a vaporiser or humidifier to help soothe the airways. Moisture can also be added to the air by running the hot shower in the bathroom and letting the steam build up. Then bring the baby into the bathroom and sit on a cushion on the floor with him/her and read a story to them while breathing in the steamy air. Nappy rash Nappy rash is one of the most common skin conditions in babies and it is also the most common skin problem in early childhood. The HSE have issued a rough guideline for parents of colicky babies that states colic usually resolves itself by the time the baby is four months of age or by six months at the latest. Coughs and colds There are many different types of coughs and colds and bronchiolitis is one of the more common illnesses that parents will come up against with their babies. It is an illness of the respiratory tract and it is caused by an infection that affects the tiny airways that lead to the lungs called the bronchioles. As these airways become inflamed, they swell and fill with mucus, which can make breathing difficult. Bronchiolitis most often affects infants and young children because their noses and small airways can become blocked more easily than those of older children or adults. It typically happens during the first two years of life and most commonly at about three to six months of age. It is more common in males, premature babies, children who have not been breastfed, and those who live in crowded conditions but it can happen to any baby. Bronchiolitis is usually caused by a viral infection, most commonly respiratory syncytial virus (RSV). RSV infections are responsible for more than half of all cases of bronchiolitis. Other viruses associated with bronchiolitis include rhinovirus (the common cold virus), influenza (flu), human metapneumovirus, adenovirus, coronavirus, and parainfluenza. Sheena Mitchell, owner and superintendent pharmacist at Milltown totalhealth pharmacy in Dublin, told IPN bronchiolitis is a viral infection and can cause inflammation and irritation to the bronchioles. “This can make it difficult for a baby to breathe,” she explained.
Sheena, a three times winner of the IPN Nurofen for Children Baby Health Pharmacy of the Year Award, explains that bronchiolitis is more common through the months of November to March and it spreads like other viral infections. “It is spread through the coughs and sneezes of infected people as it is present in the tiny water droplets in their breath. “Bronchiolitis is similar to a cold in that there is no direct treatment to kill the virus. It is really about treating the symptoms. It usually clears up itself within about two weeks and in most cases lots of minding and some extra attention at home is enough action to take.” She says the following advice is useful for pharmacists to pass along to worried parents that may come into the pharmacy looking for help and advice: 1. Check on the baby regularly – it’s one of the only times she advise setting an alarm at night to actually wake up and go to make sure the baby is ok. Always check to see if the baby is breathing and it isn’t too fast or laboured. 2. Feed the baby in the upright position to facilitate easier breathing. 3. Treat any nasal congestion using a saline nasal spray before a feed. 4. Ensure the baby is fully hydrated at all times. 5. Check the baby’s temperature if there is a suspicion that it may be high and treat them as necessary. 6. Keep smokers away from the baby, passive smoking can irritate the symptoms of bronchiolitis. 7. As bronchiolitis is caused by a viral infection, an antibiotic is pointless as it will not treat the infection so don’t be disappointed if one is not prescribed, it genuinely wouldn’t help and over use of antibiotics may cause resistance.
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Most children aged 0-3 years old develop nappy rash in some way and it is usually presents in babies from 6-8 months. Nappy rash can be caused by a number of factors including a combination of excess moisture, warmth, urine, faeces and friction in a baby’s nappy. It is a difficult environment for baby skin. The nappy rash creates an enclosed area around the bottom and this increases warmth, moisture and encourages the growth of micro-organisms that can cause infection. Chafing, due either to skin rubbing against the nappy, or from skin folds, can damage and irritate the skin and ongoing contact of the skin with urine, faeces or both, can lead to a formation of ammonia which can irritate a baby’s skin. There is also a common link made between nappy rash and teething, as well as the transition to solid foods. Pharmacists can ease a worried parent by telling them that most nappy rashes are mild and can be treated with a simple skin care routine. Most babies will not feel any pain or discomfort and it is very rare that a baby will contact a severe form of nappy rash where infection is involved. Cradle Cap Cradle cap is the name given to the yellowish, greasy scaly patches that appear on the scalp of young babies. It is a very common, harmless condition that does not usually itch or cause any discomfort to the baby. Cradle cap usually begins in babies during their first three months and tends to last a few weeks or months. It usually clears up by the time the child is two years old, although in rare cases children can have cradle cap for a lot longer. The cause of cradle cap is not clear, although it may be linked to overactive sebaceous glands, which are glands in the skin that produce an oily substance called sebum. Pharmacists can advise that cradle cap requires no specific treatment, although gently washing the
baby's hair and scalp may prevent a build-up of the scale. Administering Medications More recently, pharmacists have been urging parents of young children and babies to avoid common but potentially serious errors when administering medications. A new campaign, launched by the Irish Pharmacy Union (IPU) recommends parents to consult with their pharmacist for advice and expertise on treating common childhood ailments and administering medications. Coughs and colds, and many other common childhood ailments, can be treated successfully using over the counter medications. Daragh Connolly, President of the IPU, says, “Treating children and providing advice to parents is one of the most valuable roles played by any community pharmacist. This can include providing advice on treating conditions at home, on the safe management of any medicines and to recognise if the child needs to be referred to their GP. “One of our primary responsibilities is ensuring that medications are being safely administered. When it comes to children and babies this is even more important, as the guidelines will vary depending on age and weight and it is important that parents understand this. “Well-meaning parents, anxious to help a sick child feel better, can make mistakes in providing medications. Some of these are particularly common and include: Wrong Dose: The dose for medicines varies depending on a child’s age and weight. Even for common medications such as paracetamol or ibuprofen, this can be confusing. It is more complicated if parents have more than one child receiving the same medication. Pharmacists can calculate the correct dose and provide them with this information. Wrong Time: Accidentally repeating a dose or providing medications too close together is another common error committed by parents. Pharmacists should advise on the time that should elapse between doses and parents should always read the medications’ labels. Wrong Medicine: Many parents may offer medicine that is ineffective for specific ailments. For example, parents might give paracetamol or ibuprofen for cough or blocked nose. In the absence of pain or fever, this is not recommended. Wrong Place: Not all ailments are best treated with oral medication; eye drops, creams or nasal sprays may all be more effective for specific conditions. It is difficult for parents to accurately make these assessments.
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Health spokesperson warns of pharmacy collapse Sinn Féin Health spokesperson Louise O’Reilly TD has said the government’s inaction on funding and support for primary care is a "death sentence" to community pharmacies and general practices. Teachta O’Reilly said, “The pressure on primary care has increased significantly in recent years as our population has grown by almost half a million, and as our demographics have changed with more older people and more young children. “In a sensible and responsible State the government would recalibrate the health service towards primary care and properly fund it and invest in our GPs and our community pharmacists, it provides cheaper care and closer to home, often with better outcomes for patients. “We had a report from the Irish Pharmacy Union (IPU) stating that community pharmacies are under threat and we also had reports that the General Practice crisis is set to escalate even further.
“The IPU report warned that community pharmacies could be under threat due to what it says is the government's failure to deliver on its promise to expand their role.
“Their inaction in funding and supporting primary and community care is a death sentence to General Practice and Community Pharmacies.
“In addition to this there is the crisis facing General Practice as 150 posts are currently unfilled and 700 GPs are due to retire in next five years.
“The government needs to work on the unwinding of the FEMPI acts for primary care, they need to look at increased funding for primary and community care, and they need to enhance the primary care roles for community pharmacists.
“General Practitioners are the cornerstone of our primary care services. Primary care is the front line of our health service and deals with the bulk of the health needs of the population. “However, the government’s cavalier attitude towards GPs in their refusal to reverse cuts to primary care is crippling services.
“If this is not done then general practice and community pharmacists will collapse nationwide. “If the government were serious about implementing Sláintecare they would be investing in primary care.”
New arrival at MedPharm Ireland’s leading primary care recruitment company has just recruited Garry O’Riordan. Garry has extensive experience recruiting pharmacists across Ireland, as well as working in-house with LloydsPharmacy on their recruitment process. With over 12 years experience and a former director with Pharmaconex, Garry brings a wealth of experience and know-how to MedPharm, part of the Med Doc Healthcare Group. Garry O’Riordan, MedPharm and Tom Garvey, Med Doc Healthcare
extensive experience in healthcare recruitment, in particular, within the primary care arena. Together, Tom and Garry have ambitious plans for MedPharm with expectations that it will follow in its parent company footsteps, by providing global staffing solutions to domestic problems.
Based in Dublin 2, MedPharm is in the heart of Dublin city centre and ideally placed to recruit the brightest talent in pharmacy. MedPharms parent company, Med Doc, is one of the main suppliers of GPs, practice nurses and triage
nurses to Ireland’s primary care centres and out of hour’s clinics across Ireland, including HSE Primary Care. Garry joins Tom Garvey of Med Doc Healthcare who both have
As well as having previously recruited for most major chains in Ireland and independents, Garry has also attended previous conferences and events and even presented an award at the IPN annual Pharmacy awards. In addition to this, Garry has recruited from all around the globe and really understands the staffing shortages facing pharmacies across Ireland. Garry can be contacted via: Tel: +353 1 9011730 Mobile: +353 87 607 8010 or Email: firstname.lastname@example.org
High Fat diet risks APC Microbiome Ireland scientists based at University College Cork have shown for the first time that a high fat “western” diet reduces the efficiency of the immune system to fight infectious disease particularly in the gut, and to infection with the foodborne pathogen, listeria monocytogenes. The researchers found that feeding mice with a “westernised” diet, which is high in fat and low in fermentable fibre, affected both the immune system and the bacteria resident in the gut (the gut microbiota). Even shortterm consumption of the high fat diet was found to increase the number of goblet cells in the gut, which are the target for infection by Listeria, as well as causing profound changes to the microbiota composition and immune system. The high fat diet also increased susceptibility to infections beyond the gut. Increased human consumption of a ‘westernised’ diet has been linked to the dramatic rise in conditions such as obesity and type 2 diabetes, and research has demonstrated the direct effects of dietary fats upon both the immune system and the gut microbiota. “Short-term consumption of the high fat diet increased levels of Firmicutes bacteria in the gut which are associated with obesity,” said PhD student Vanessa Las Heras, who carried out the study at the flagship Science Foundation Ireland Research Centre. “The effects of diet were also seen beyond the gut, with reduced levels of immunity throughout the body, local alterations to gastrointestinal cell function and changes to the gut microbiota that enhanced the progression of Listeria infection.” “This has important implications for human health, especially during pregnancy, in old age and in immunocompromised individuals. It also has more general implications for research on infectious disease” said Dr Cormac Gahan, leader of the research study.
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Continuing Professional Development
CPD 100: ALLERGIES This module is suitable for use by community pharmacists as part of their Continuing Professional Development. After reading this module, in the magazine or online, complete the post-test on our website at www.pharmacynewsireland.com and include in your personal CPD ePorfolio. Biography - Since becoming owner of Whelehans, Eamonn Brady MPSI has striven to build and grow his business around his philosophy of placing his customer led, independent pharmacy firmly at the centre of his community and to extend its reach through engagement “outside the front door” with the public and local groups. At the core of Eamonn’s vision of his own role as a community pharmacist, is his belief that prevention is better than cure and to “help people to help themselves” through education and information initiatives delivered in a variety of ways.
Management of Allergic Rhinitis 60 SECOND SUMMARY Hay fever affects the nose, sinuses, throat and eyes. Hay fever usually occurs during the spring and summer months. Exactly when it occurs depends on which pollens the person is allergic to. Hay fever is a common condition that affects around 20% of the population. Hay fever is more likely if there is a family history of allergies, particularly asthma or eczema. It is estimated that up to 50% of asthmatics and up to 30% of eczema sufferers also have allergic rhinitis. Hay fever usually begins in the early teens and peaks when a person is in their twenties. Hay fever cannot be cured completely. Data suggests children sometimes improve with age, although many have persistent and worsening symptoms. In adults, the condition is usually persistent with some improvement in older age. To determine if a patient has allergic rhinitis, the doctor will ask questions to determine cause and type of allergy including the time of day and year the rhinitis occurs (to distinguish seasonal and perennial rhinitis), family history of allergies, medical history, information about medication used including decongestants which can cause a rebound effect and information on pets. Skin tests may be performed. Patients are usually tested for a panel of common allergens. Skin tests are rarely needed to diagnose mild seasonal allergic rhinitis, since the cause is usually obvious. The skin test is not appropriate for children younger than age 3. Patients should not take anti-histamines for 12 to 72 hours prior to the skin test otherwise the allergy will not show up. As total avoidance of triggers is impossible, medication is often needed to control symptoms. Treatment in advance of first symptoms is an important aspect of management of hayfever. For example, starting treatment in April; prior to the normal summer increase in pollen count.
Allergic rhinitis is inflammation of the nasal passages caused by an allergen, such as pollen, dust, mould or skin flakes from certain animals. Hay fever is a type of allergic rhinitis caused by pollen or spores. Hay fever affects the nose, sinuses, throat and eyes. Hay fever usually occurs during the spring and summer months. Exactly when it occurs depends on which pollens the person is allergic to. From May to July grass and flowers are in pollen, so this is the most common time for hay fever. Most common type of allergic rhinitis is Hay fever so I will refer to Hay fever commonly in this article. Trees, grass and plants release pollen as part of their reproductive process. Mould and fungi also release tiny reproductive particles, called spores which also cause allergies. People with hay fever can experience symptoms at various times of the year, depending on which pollens or spores they are allergic to. Grass is the commonest allergen implicated with symptoms of hayfever. Hay fever is a common condition that affects around 20% of the population. Hay fever is more likely if there is a family history of allergies, particularly asthma or eczema. It is estimated that up to 50% of asthmatics and up to 30% of eczema sufferers also have allergic rhinitis. Hay fever usually begins in the early teens and peaks when a person is in their twenties. Symptoms Symptoms of hayfever include sneezing, running nose, watery eyes, nasal congestion, itching in the throat, eyes
Continuous Professional Development Modules are supported by Nasacort Nasacort has no editorial oversight of the CPD programmes included in these modules.
Reflection - Is this area relevant to my practice? What is your existing knowledge of the subject area? Can you identify any knowledge gaps in the topic area? Planning - Will this article satisfy those knowledge gaps or will more reading be required? What resources are available? Action - After reading the article complete the summary questions at www. pharmacynewsireland.com/cpdtraining and record your learning for future use and assessment in your personal log. Evaluation - How will you put your learning into practice? Have I identified further learning needs? Published by IPN, supporteded by Nasacort. Copies can be downloaded from www.irishpharmacytraining.ie Disclaimer: All material published is copyright, no part of this can be used in any other publication without permission of the publishers and author. Nasacort has no editorial oversight of the CPD programmes included in these modules.
and ears and swelling around the eyes. Patients with asthma often find that asthma symptoms, such as wheezing and breathlessness, get worse when they have hay fever as well. Sometimes, asthma symptoms only occur during the hay fever season. Allergic reaction Allergic Rhinitis is an autoimmune condition so symptoms occur when the immune system overreacts to a normally harmless substance (e.g.) pollen. When the body encounters an allergen, cells in the lining of the nose, mouth and eyes releases histamine triggering symptoms of an allergic reaction.
CPD 100: ALLERGIES
Prognosis Hay fever cannot be cured completely. Data suggests children sometimes improve with age, although many have persistent and worsening symptoms. In adults, the condition is usually persistent with some improvement in older age. Hayfever can cause serious symptoms if left untreated. Total nasal obstruction may cause sleep apnoea, frequent sinus infections, interference with daytime breathing and ear infections. Seasonal Vs Perennial Hayfever- If allergen exposure is seasonal, the most likely culprits are tree, flower and grass pollen and the symptoms are predictable and reproducible. Seasonal allergic rhinitis may therefore be diagnosed by the history alone. By comparison, classic perennial allergic rhinitis is associated with nasal symptoms, which occur for more than two hours per day and for more than nine months of the year.3 Perennial allergic rhinitis usually reflects allergy to indoor allergens like dust mites and animal fur. In perennial allergic rhinitis, nasal congestion is common while itchy and streaming eyes is less frequent.6 Pollen Count- Hay fever symptoms are likely to be worse if the pollen count is
high. This is not determined simply by how many flowers there are, but also by the weather. The amount of sunshine, rain or wind affects how much pollen plants release. Hay fever symptoms tend to begin when the pollen count is over 50. The pollen count is highest in the early evening, so hay fever sufferers are advised to avoid going outdoors at this time. On humid and windy days, pollen spreads easily. On rainy days, pollen may be cleared from the air causing levels to fall. Diagnosis To determine if a patient has allergic rhinitis, the doctor will ask questions to determine cause and type of allergy including the time of day and year the rhinitis occurs (to distinguish seasonal and perennial rhinitis), family history of allergies, medical history, information about medication used including decongestants which can cause a rebound effect and information on pets. The doctor will examine the inside of the nose with an instrument called a speculum. The eyes, ears, and chest may also be examined. Skin tests may be performed. Patients are usually tested for a panel of common allergens. Skin tests are rarely needed to diagnose mild seasonal allergic rhinitis, since the cause is usually obvious. The
skin test is not appropriate for children younger than age 3. Patients should not take anti-histamines for 12 to 72 hours prior to the skin test otherwise the allergy will not show up. Tiny amounts of suspected allergens are applied to the skin with a needle prick or scratch. The patient is tested with selected diagnostic vaccines of tree, grass, or weed pollen, mould, house dust mite, and/or animal allergens. A hive will develop at skin test site within 20 minutes if there is an allergy. Skin allergy tests are popular because they are convenient and inexpensive. They are not 100% accurate. The doctor may take a nasal smear. The nasal secretion is examined microscopically for factors that might indicate a cause, such as increased numbers of white blood cells, indicating infection, or high eosinophil count. High eosinophil counts indicate an allergic condition. Blood tests for IgE immunoglobulin production may also be performed. One test is called the radioallergosorbent Test (RAST), used to detect increased levels of allergen-specific IgE in response to particular allergens. Further tests may involve a CT scan or a nasal endoscope. Treatment People suffering from hayfever need to
Continuous Professional Development Modules are supported by Nasacort Nasacort has no editorial oversight of the CPD programmes included in these modules.
CPD 100: ALLERGIES try to reduce explosive to triggers such as pollen and dust. I will deal with tips on how to reduce exposure to triggers later in this article. As total avoidance of triggers is impossible, medication is often needed to control symptoms. Treatment in advance of first symptoms is an important aspect of management of hayfever. For example, starting treatment in April; prior to the normal summer increase in pollen count. There are many treatments available to relieve the symptoms. These include antihistamine tablets, nasal sprays and eye drops. Some can only be prescribed by a GP, but many are available over-the-counter (OTC) in pharmacies. Antihistamines Antihistamines are the most frequently used oral medicines for the treatment of hay fever. Many are available without prescription and are a reasonable first line choice for many patients. They are effective in relieving eye symptoms, running nose, sneezing and nasal irritation but have negligible effect on nasal congestion. Antihistamines are useful in patients with troublesome symptoms at multiple sites e.g. itching of roof of the mouth, throat or eyes. However, antihistamines may have side effects and drug interactions. There are two main groups of antihistamines: First generation and Second generation. First Generation Antihistamines ("Sedative") Sedation is the most common side effect of these drugs and may affect the patient’s ability to drive and operate machinery and concentrate. They should not be used in patients with prostatic hypertrophy or narrow angle glaucoma. Tolerance to their side effects may develop. Chlorpheniramine (Piriton®) is available over the counter in pharmacies. Piriton® can cause mild drowsiness. Second Generation Antihistamines ("Non- Sedative") Examples include desloratadine (Neoclarityn®), fexofenadine (Telfast®), levocetirizine (Xyzal®), loratadine (Clarityn®) and cetirizine (Zirtek®, Cetrine®). They only require once daily dosage and are non-drowsy. Loratadine and cetirizine are available over the counter without prescription. The non-sedating
antihistamines are fast acting, have no reported cardiac side effects, and are not affected by the presence of food in the stomach. However, loratidine is best avoided in elderly patients and patients with liver problems. Decongestants Decongestants have a limited role in hay fever and should be reserved for periods of severe nasal congestion. Nasal decongestants sprays and drops such as Otrivine® should not be used for longer than three to five days because of the possibility of rebound congestion which makes the problem worse. Corticosteroids Nasal drops and sprays reduce inflammation and swelling of the nasal mucosa and in normal dosage side effects are minimal. It is best to start treatment a few weeks before the season begins. All corticosteroids nasal sprays appear to have similar efficacy. Fluticasone (Flixonase®), beclomethasone (Beconase®), Triamcinolone (Nasocort®) Mometasone (Nasonex®) are the most regularly used. People find the once daily dosage regimen of Nasocort®, Flixonase® and Nasonex® convenient. Side effects are mild and transient and consist of nasal irritation and stinging, dryness, sneezing, sore throat, nose bleeds and fungal
Continuous Professional Development Modules are supported by Nasacort Nasacort has no editorial oversight of the CPD programmes included in these modules.
overgrowth. They should be avoided during nasal infections. Flixonase® and Beconase® are available to buy over the counter in pharmacies. Oral steroids (e.g.) prednisolone or depot injections (e.g.) triamcinolone (Kenalog®) are only prescribed for certain groups of patients such as those doing exams or those with severe continuous symptoms despite adequate standard therapies. Others Ipratropium bromide nasal spray (Rinatec®) may be prescribed where running nose is the predominant symptom. It does not relieve itching, sneezing or nasal blockage. Azelastine (Rhinolast®) is a prescription only nasal antihistamine spray with a rapid onset of action. It may provide an effective and safe alternative to oral medications. Otrivine Antistin® eye drops are fast acting antihistamine eye drops available over the counter. Hayfever and Pregnancy Topical corticosteroids (sprays and drops) should be used in preference to antihistamine tablets if drug treatment is needed. Topical corticosteroids can be used but high doses of oral corticosteroids should be avoided. Sodium cromoglycate is safe to use. The
CPD 100: ALLERGIES Instead, allergic rhinitis can either be: • intermittent: symptoms are present for up to four days a week, or for up to four weeks in a row, or • persistent: symptoms are present for more than four days a week, or for more than four weeks in a row. These terms have been changed to better reflect the reality of people’s symptoms. Previously, seasonal used to mean an allergic reaction at a particular time of the year, usually caused by outdoor allergens, such as pollen. Perennial meant that the allergic reaction symptoms lasted all year, and were usually caused by indoor allergens, such as dust mites. Pollens can be present and cause allergic reaction symptoms throughout the year, and those with allergies to all year allergens, such as dust mites, may not have their symptoms all year round. References sedating antihistamines, chlorpheniramine (Piriton®) and promethazine (Phenergan®) may be prescribed in severe cases and only if topical treatment is ineffective. Immunotherapy Immunotherapy is the use of allergen vaccines containing house dust mite, animal fur or extracts of grass or tree pollen. By gradually increasing the patient’s exposure to the allergen that causes the allergy, the patient becomes tolerant to it. Immunotherapy is only used in patients with severe symptoms and must be done by a specialist. However, long term relief can be achieved. Grazex® is a grass pollen extract available in tablet form which is now available on prescription for patients who have failed to respond to other hayfever treatments. Grazex® must be started at least 4 months before pollen season and should be continued for up to 3 years. Prevention The pollen count is often given with TV, radio, internet, or newspaper weather forecasts. If it is humid or windy, the pollen count is likely to be higher. Generally, the pollen count is highest in the early evening, so try to avoid going outside around this time. Keep windows and doors shut in the house if it gets too
warm, try drawing the curtains to keep out the sun and keep the temperature down. Avoid cutting grass, playing, walking or camping in grassy areas. Change clothes and take a shower after being outdoors to remove the pollen from the body. Wear wrap-around sunglasses to stop pollen getting in the eyes when outdoors. Keep car windows closed, and consider buying a pollen filter for the air vents in the car. Keep fresh flowers out of the house, and vacuum (ideally using a machine with a HEPA filter) and damp dust regularly. Do not smoke and stop other people from smoking in your house. Smoke irritates the lining of the nose, eyes, throat and airways which can make symptoms worse. Keep pets out of the house during the hay fever season; if pets normally come indoors, wash regularly to remove any pollen. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines
1) DeShazo R, Kemp S. Update. Clinical manifestations and epidemiology of allergic rhinitis (rhinosinusitis) 2010; p4 2) Linna, O, Kokkonen, J, Lukin, M. A 10-year prognosis for childhood allergic rhinitis. Acta Paediatr 1992; 81:100. 3) Dykewicz, MS, Fineman, S, Skoner, DP, et al. Diagnosis and management of rhinitis: Complete guidelines of the Joint Task Force on Practice Paramaters in Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 1998; 81:478. 4) Dottorini, ML, Bruni, B, Peccini, F, et al. Skin prick-test reactivity to aeroallergens and allergic symptoms in an urban population of central Italy: a longitudinal study. Clin Exp Allergy 2007; 37:188. 5) South Med J 1996;89:1130-1139 6) St James Hospital Dublin. GPs, Healthcare Professional Newsletters, NMICBulletins, 1997/VOL3-2. Hayfever
The ARIA guidelines were developed during a World Health Organization (WHO) workshop in 1999 by a panel of experts. They were updated in 2008.
7) Ann Allergy Asthma Immunol 1996; 77:225-259
The ARIA guidelines have changed the terms that were traditionally used to describe allergic rhinitis. Allergic rhinitis is no longer described as seasonal when it occurs during the summer months and perennial when it occurs all year round.
10) Mod Med Aus; 1994;3 7:74-86
8) N Eng J Med. 1991; 325:860-869 9) Drugs 1993; 45:518-527
11) J Allergy Clin Immunol 1996; 98:307-318 12) Pharm J 1996; 256:188-191 13) J Allergy Clin Immunol 1996; 98:307-318
Hay Fever - Key Market Trends Key market trends in the Child and Babycare Category identified and discussed by Anne-Sophie Martin, Brand manager for GP number 1 recommended, 100% natural sea water nasal spray brand STÉRIMARTM. symptoms quickly and effectively. It also presents an opportunity to not only drive sales on treatments but also support this as upsell of products with preventative properties, or natural products that can complement their existing treatment choice for more efficient management of symptoms.
According to Mintel reports, not only do a quarter of parents in the UK who have children between the ages of 0 to 2 like to use natural alternatives to personal care products on their children, but one fifth are worried their children are sensitive or allergic to certain ingredients in personal care products. This means that many parents now not only want to know that products are effective, and ‘more natural’ but also they are becoming much more aware of what the different ingredients are in the products they are using, investigating that their full ingredient list is completely safe before believing brand and packaging claims. This is a trend that is predicted to grow throughout the healthcare market in general, as shoppers become more conscious about what they are putting in their own and especially their children’s bodies, opting for products that they perceive to be the ‘healthier alternative’ with minimal or no risk of potential side effects. It is not enough for brands to just state their natural qualities anymore, they need to be able to prove it with ‘nothing to hide’ ingredients and straightforward claims clearly stated on pack. But while they are becoming more savvy, research conducted on behalf of STÉRIMARTM towards the end of 2016 showed that while parents are open to trying new products if they think they will work and are recommended by peers, they are still looking to GP’s
as a first port of call for advice on treatment. This is mainly due to the fact that they think the childcare category can be confusing and hard to navigate themselves, with many products lacking clear benefits and reasons to believe.
price rising by £0.25. New launches and higher price points play a key role in contributing to the growth in this area, mainly driven by decongestants, although hay fever is also a strong subcategory.
This is a great opportunity for Pharmacies to bridge the gap between GP advice and peer recommendation, helping parents to navigate through the array of products available. By ensuring that staff are knowledgeable* about which products are not only effective, but also the ones that are most often recommended by GPs and which are completely natural, will help position them as a trusted and convenient destination for parents to get advice and treatment recommendation for their children. This can be coupled with ensuring that the childcare products are well categorized at shelf to make it easy for parents to navigate at point of sale. If possible, products could be grouped by ailment and put in age suitable order.
STÉRIMAR™ range of natural sea water based nasal sprays is one of the brands that has helped drive the growth of the Nasal Spray category. Last year, Stérimar grew by 18.3% and attracted an impressive 77k more shoppers. Stérimar is now standing as the 7th largest brand in the whole nasal treatment market with the second largest percentage value growth. The brand is also thriving across the sub-categories becoming the 6th biggest brand in the decongestant sector, the 4th biggest brand in the children’s sector and the 3rd biggest brand in the overall hayfever sector.
Opportunities for pharmacy businesses with the Stérimar™ children’s range According to Kantar Worldpanel and Nielsen Scantratck data 28.01.2017, the Nasal Spray category is a growing area within healthcare. In 2016 the Nasal Spray market grew by 10.3%, attracting 91k more shoppers than the previous year, with the average
This is supported by the fact that it is the UK’s GP number 1 recommended brand as well as the fact that the products in the children’s range contain only natural sea water and purified water with some additional copper salts for Stérimar Kids. These gentle yet effective products tick several of the key boxes for parents who are seeking healthier alternatives.
Stérimar hay fever products have a base of 100% natural purified sea water and can be used alongside a nasal congestion medication and antihistamines based on medical advice. This means that pharmacists are able to up sell and widely recommend Stérimar in the knowledge that it is safe to use and will not cause any rebound congestion. Customers should also be educated on the relevance of preventative solutions when tackling hay fever symptoms. As the first line of defence against pollen, it is essential to keep your nose as healthy as possible to help protect from the symptoms of hay fever. Washing your nose daily with an isotonic solution will simply wash away contaminants and debris trapped in the nose while helping prevent the onset of allergic reactions and ensuring the nasal lining is kept moistened.
How to Make the Most of the Hay fever Sub-category?
Advise your customers to start using Stérimar nasal sprays well in advance and a couple of weeks before they usually start experiencing symptoms and to keep using it regularly throughout the season to keep symptoms at bay.
Anne-Sophie Martin says, “Pharmacies should present themselves as the convenient destination for informative advice and products that will address
*You can now avail of in store training with our Product Trainer Annette O’Sullivan – simply enquire through your Intrapharma Rep to arrange this.
For more information, samples and pricing please contact your Intrapharma Representative on 01463 2300
Listen out for the Pollen Count brought to you by Sterimar April to July
Topic Team Training – Bladder Weakness A community pharmacy environment that fosters teamwork ensured high levels of consumer satisfaction. This series of articles is designed for you to use as guide to assist your team in focusing on meeting ongoing CPD targets and to identify any training needs in order to keep the knowledge and skills of you and your team up to date. Is the pharmacy team confident in informing pharmacy customers on the recommended treatment? Is the pharmacy team educated and knowledgeable on the dosage and contra-indications for all medications? Is there any further training required to assist the team discussing bladder weakness advice with customers? Key Points: Check your pharmacy team are aware and understand the following key points: Customers that should be referred to the pharmacist Ensure you are providing discreet advice to assist those presenting in the pharmacy Display discreet posters and shelf-signage to encourage people to consult with the pharmacy team The below information, considerations and checklist provides support to enable you to run a team training session and identify opportunities for learning within the topic of Bladder Weakness. One in seven women and one in eight men will visit their local pharmacy for advice about bladder weakness instead of their GP, research has shown. One in three women and one in four men over the age of 40 experience bladder weakness at some point in their life, making it far more common than people may think. It is also common only to experience nocturnia, bladder weakness at night. Symptoms can either be a long-term or short-term occurrence, dependent on a number of triggers, from lifestyle choice to unprovoked illness. For the urinary system to do its job, the brain, muscles and nervous system
need to work together to hold urine in the bladder and not release it until you are ready. However, there are many factors that can interfere with this process. Common causes of bladder weakness, which are not unique to either sex, include urinary tract infections, medication such as diuretics, being overweight, leading to extra pressure on the abdominal and pelvic muscles and conditions such as diabetes or neurodegenerative diseases (for example, Alzheimer’s). There are also links to smoking causing stress urinary incontinence from increased coughing. For many, the physical and hormonal changes that occur during milestones such as childbirth and the menopause – abdominal pressure during pregnancy and reduction in the quantity of oestrogen during menopause – can cause the pelvic floor muscles that keep the urethra closed to be weakened.
Pharmacists and their staff have a real opportunity to help. Whether it is the person suffering or a family member or carer asking for advice, pharmacy teams can listen to concerns and try to identify what may be causing the condition. They can reassure the person that incontinence or bladder weakness is a common ailment and there are steps they can take that will help. Consider: Have I, or any of my team, established the cause of bladder weakness? Am I, or any of my team, able to identify the common causes of urinary incontinence and bladder weakness? Is the pharmacy team aware of the different types of bladder weakness from stress incontinence to urge incontinence?
Those experiencing blood in the urine or if their condition is getting worse should always be referred to their GP Actions: Ensure discreet merchandising of products such as pads and disposable pants Ensure you and your team are aware of presenting features in order to ensure treatment for the right condition. For example when is the customer experiencing bladder weakness? How much urine do they lose? Barrier creams can also be stocked, as incontinence sufferers often develop fungal infections and contact dermatitis Locate products in a quiet area visible from the pharmacy so people can be approached to see if they need help Train the team to meet all the above considerations
Types of Bladder Weakness Table 1: Stress Incontinence
Due to increased abdominal pressure under stress (weak pelvic floor muscles)
Due to involuntary contraction of the bladder muscles
Due to blockage of the urethra
Due to impaired functioning of the nervous system
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Lifestyle advice which may help with the problem, such as quitting smoking or losing weight
Learning The Continence Foundation of Ireland www.continence.ie Knowing the types of bladder weakness and the causes for each, will help pharmacists and their teams make the best recommendations – See Table.
Haven Pharmacy Launch New Pharmacy in Enniscorthy Kavanagh’s Pharmacy in Enniscorthy Co Wexford is the latest pharmacy to join the Haven Pharmacy Group. On the 22nd February 2019, Kavanagh’s Enniscorthy launched their newly branded Haven pharmacy which offers a diverse product range, health services & screenings and promotions as well as outstanding customer service. “We’ve been operating in our local community for almost 30 years now but now as part of the wider Haven Pharmacy Group we can share knowledge, best practice, latest thinking and buying power. Pharmacy consumers expectations are far greater now” said pharmacist and owner Dermot Kavanagh “and we are happy that we will continue to meet, and even exceed, those expectations in Enniscorthy.” Celebrations kicked off with South East FM Radio broadcasting live from the pharmacy, with DJ Tony Scott interviewing Dermot Kavanagh and staff members Louise O’Connor and Jayne Balfe. There was great banter among staff and customers as Tony also interviewed Frank O’Connor and Ivy Dillane, loyal customers of Kavanaghs Pharmacy since it first opened back in 1990. Louise O’Connor spoke about how she
has been working for Dermot & Mary Kavanagh since she was 17 and how they are the best employers to work for “they are so caring and compassionate in everything they do for their staff and customers. I recommend to anyone who has not been here before to pop in to us and become a friend”, customers become friends in Kavanaghs Enniscorthy and that doesn’t change now they have become part of the Haven Pharmacy group. “The same great staff will continue to work here serving the local customer they know best. Our name will continue to be a very relevant part of who we are and our role in the community. This is an important next step in how we evolve and develop with Haven Pharmacy, a name which is synonymous with expert, professional healthcare, delivered locally - always offering great value, a varied product range and exciting new services to local pharmacy customers all over Ireland” continued Dermot. As customers passed through the doors, the staff of Kavanaghs knew the name of every customer
Proprietors Dermot & Mary Kavanagh and their children – who enjoyed face painting by Shine Bright Theatre and received party bags as the radio played their favourite requests. But it wasn’t just the children who were treated, everyone enjoyed an array of sweet & savoury treats catered by Kilcannons of Enniscorthy who also made the spectacular Haven celebration cake! There were goody bags for everyone as well as raffles for hampers with fantastic products from brands such as Neostrata and Uriage. It was great to see the men from the local Enniscorthy Mens Shed also on the day who called in to wish Dermot and his team good luck. “Haven Pharmacy is already recognised within the industry
as a leader in expert, healthcare advice, and the depth and scope of our knowledge is significant. I’m looking forward to being part of the Haven team” said Dermot In a market of increased self-care and self-medication the relationship between the consumer and the pharmacist is becoming even more important with the customer relying more on their pharmacist for the latest and most expert health care advice. Community pharmacists are regarded as the most accessible healthcare experts in primary care, this bodes well for Haven Pharmacy as trust, expert & professional care and personal service are at the core of what they do daily. “This is a pharmacy brand for today’s pharmacy consumer, offering independent local communities the highest level of clinical excellence and expert advice from their own local pharmacist I am very excited about the opportunities ahead and the positive future as a member of Haven Pharmacy” commented Dermot. Haven Pharmacy Kavanaghs offer the following services: • Blister Packing • Blood Pressure Monitoring • Smoking Cessation Consultation • Weight Management • BMI Testing • Passport Photos • Photo Kiosk
Niall Kavanagh, Orla Murphy MPSI, Louise O’Connor, Philomena Fortune, Dermot Kavanagh MPSI, Mary Kavanagh and Jayne Balfe
For more information log on to www.havenpharmacy.ie
Haven Pharmacy Kenny’s Tramore store celebrates 10-year anniversary with new store opening After 10 years serving the local community, Haven Pharmacy Kenny's success story continues as they recently opened a second Haven Pharmacy in Tramore. Hundreds of customers turned out for the opening of the new Haven Pharmacy on lower Branch road and the 10-year celebrations in Elm Park. The new store, ideally located beside the family Medical Centre offers a range of products, services, health screenings, and a unique and friendly experience for the local community that Haven Kenny’s prides itself on. “We are retaining all the very best of what we have at Haven Kenny’s including more health screenings, more outreach talks in the local community, regular health talks instore and lots of special offers and promotions tailored specifically for our customers, all in a dynamic and refreshing new store environment,” says Pharmacist Paul Kenny. The new branch is located beside the family Medical Centre and is the first pharmacy in the lower part of town. It will be very convenient for those living on the Waterford side of Tramore as well as for tourists all year round. People coming from the beach, hotels and local amenities will not have far to travel. The Elm Park pharmacy will continue with business as normal in the upper part of town looking after the growing population there and the schools too. “Prescriptions can be handled at either outlet and it is also easy to transfer prescriptions from any other pharmacy,” says Paul. Staff are key to the success of the whole operation. “Just as our wonderful staff at Haven Kenny’s Elm Park have served the community with the utmost of care over the past ten years, it is our aim to ensure that that ethos of family friendly, expert, conﬁdential care will continue at the Branch Road pharmacy also,” Paul added. They are delighted to have recruited Pharmacist, Laura
The new team at Haven Kennys Branch Road - Daniella Kirby, Lynsey O’Neill, Gwen Flavin and Laura Sherlock (Pharmacist)
Sherlock, who previously worked for Boots in Tramore to head up the Branch Road pharmacy. Laura has vast experience in community pharmacy and comes to the job with a wealth of knowledge. Tracey Pierce, Manager of Haven Kenny’s Pharmacy Elm Park, who along with Grace Byrne, has been with Paul from day one, will also take the helm in Branch Road. Joining them will be Technicians Orla Bolster and Gwen Flavin together with OTC staff Lynsey O’Neill and Daniella Kirby. The well known and loved staff members from Elm Park will from time to time be serving customers at the new venture also so customers can look forward to a very integrated experience all in all.
Orla and Paul Kenny with the team at Kennys Elm Park Tracey Pierce, Orla Bolster, Lauren English and Fiona Cullen
With over 20 years working as a Pharmacist in an everchanging industry, Paul has wide ranging knowledge of the business he operates. Haven Pharmacy Kenny’s were also delighted to mark the 10th anniversary of the opening of their ﬁrst store at Elm Park on the same day. Paul and his pharmacy family are great sponsors and supporters of local schools, sports clubs and charities. They were delighted to be in a position to donate a deﬁbrillator to the Holy Cross National School and they provide valued sponsorship to the local GAA and Soccer Clubs as well as sponsoring many of the talented individual sportspeople shining a light for Tramore across a range of sports in recent years, Rhys Moran
The new Haven Pharmacy at Branch Road Tramore in Boxing and Nick McCarthy in Surﬁng to name but a few. In years gone by they sponsored the local Tennis Club and as members of Tramore Golf Club for generations, the Kenny’s sponsor a week of golf in Tramore Golf Club annually. They are looking forward to continuing to support their local community in any way they can over the coming years. “Haven Pharmacy is a cooperative group that has been designed to appeal to the local consumer, with local needs, but who will also be able to beneﬁt from the shared knowledge, services and value offered by being part of a national network. Each Haven team member is dedicated to the people and economy of their local area.” Paul commented. Kenny’s Pharmacy’s Elm Park and
Branch Road offer many services on a daily basis: • All Prescriptions dispensed Blister packs and home deliveries for the elderly and infirm • Out of hours emergency services when required • In-Store Chiropody service at Elm Park by appointment • Flu Vaccines Blood Pressure Screening • Managed Weight Loss Programmes • BMI checks • Private Consultations The team at Haven are looking forward to serving the community of Tramore for many more decades to come.
ALL THE POWER
DECONGESTANT Zirtek Plus Decongestant delivers all the allergy relief of Zirtek with added decongestant for up to 12 hours of control Helping to relieve symptoms including blocked or runny noses, sneezing and itchy eyes associated with indoor allergies and hayfever Awareness and sales driven by high-profile marketing activity, including a new website and online activity
To place your order please contact your local Pemberton rep or customer services on: Tel: 01-463 2424 Email: firstname.lastname@example.org
Please consult the Summary of Product Characteristics before prescribing, information about this product can be found at www.medicines.ie Further information is available on request from UCB Pharma Ireland Ltd, United Drug House, Magna Drive, Citywest Road, Dublin 24 MA Numbers:
Zirtek 1 mg/ml oral solution: PA 891/8/3, Zirtek Plus Decongestant 5/120mg Prolonged Release Tablets PA 891/8/1, Zirtek Tablets PA0891/008/005
Product licence holder:
UCB Pharma Limited
Zirtek tablets & oral solution: Cetirizine dihydrochloride Zirtek Plus Decongestant prolonged release tablets: Cetirizine dihydrochloride, Pseudoephedrine hydrochloride
Legal Category: OTC
Adverse events should be reported to the Health Products Regulatory Authority at www.hpra.ie or via email to email@example.com Adverse events should also be reported to UCB Pharma Ireland Ltd via email UCBCares.IE@ucb.com
July 2018 UK/16ZI0052
JOIN US IN CELEBRATING EXCELLENCE IN COMMUNITY PHARMACY “There are no secrets to success. It is the result of preparation, hard work and learning from failure” In launching the eighth annual Irish Pharmacy Awards, we are seeking to uncover those individuals and teams putting in the groundwork quoted above to the enhancement of community pharmacy throughout Ireland. The Irish Pharmacy Awards represent a unique and high-profile opportunity to celebrate the excellence and amazing achievements of Ireland’s pharmacy professionals, and reaffirm Irish Pharmacy News’s commitment
to the core pursuits of pharmacy: excellence in health and innovation. The Awards recognise outstanding examples of high standards, best practice, innovation and excellence. It has been, and continues to be, the goal of Irish Pharmacy News to recognise the exact added value of the contribution made by community pharmacists and their teams. Through the submissions to these Awards and the examples of innovation that they demonstrate, IPN want to inspire you to think about your role, that of your team
and of the community pharmacy profession in which you operate, as a whole. The 15 Award Categories detailed on the forthcoming pages are inviting entries across a broad spectrum of fields; from innovation and business development, to the rising stars of the profession and the teams and individuals making a difference. The aim of the Irish Pharmacy Awards is to celebrate, recognise and reward those displaying dedication and commitment. They also create a platform which fosters shared learning and education.
The closing date for all entries is April 1st, 2019. After this, our prestigious judging panel, comprised of pharmacy, industry and business leading professionals, will face the difficult task of shortlisting and selecting the overall winners. The winners will be announced at a gala dinner in the Clayton Hotel, Burlington Road, Dublin on Saturday, May 18th, 2019. To win one of the 15 categories this year is a true accolade to the hard work put into community pharmacy.
Awards Charity Partner Spinal Injuries Ireland (SII) is the only organisation of its kind in Ireland. The aim of the organisation is to consistently provide specialist, personalised support to individuals who have sustained a spinal cord injury and their families. A Spinal Cord Injury is one of the most devastating and destructive injuries that can happen to a person. Not only can the injury result in a loss of limb movement and function, it can also mean chronic pain, loss of bowel and bladder control, a weakened immune system and blood pressure issues amongst the many physiological effects, depending on the severity of injury. For some the emotional and psychological impact can be even more overwhelming than the physical as a Spinal Cord Injury demands the rebuilding of a person’s life. Spinal Injuries Ireland is dedicated to being there every step of the way; supporting at every stage for as long as we are needed. SII currently work with over 2000 service users across the country with a further 3 people per week currently being diagnosed with a spinal cord injury in Ireland. Three quarters of those with a Spinal Cord Injury are unemployed and 40% live on or below the poverty line currently. Physical barriers, misconceptions, accessibility issues and a struggle for the right resources can result in the exclusion of many people from full participation in society. We, at SII, believe a paralysed body should not mean a paralysed life. Our mission is to ensure that all people who have spinal cord injury have equal access to the supports they need to live, to work, to feel fulfilled and to participate fully in their communities.
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Awards The Irish Pharmacy
PHARMATON PEOPLE’S PHARMACIST OF THE YEAR AWARD 2019 The Pharmaton People’s Pharmacist Award is the only category within the Irish Pharmacy Awards in which nominees are voted for by members of the public, their local communities and peers, giving patients the opportunity to both nominate, and vote for, their local pharmacist. A nationwide launch will take place in April to launch the search for the 2019 Pharmaton People’s Pharmacist, whereby nominations will be sought from across the country. We will want to hear stories about how local pharmacists are making a difference to the lives of those in their communities, who have gone the extra mile. With over 2 million Irish people visiting a community pharmacy every month, pharmacists are ideally placed to be the first port of call before a visit to the local GP Surgery. Pharmacist’s expert knowledge and skills enable them to support their communities by promoting healthy lifestyles, delivering flu vaccines, managing blood pressure and cholesterol checks, preventing long term illness such as asthma and diabetes and guiding individuals to better manage their medicines The public campaign calling for nominations will run until from XXXXX The Pharmaton People's Pharmacist of the Year Award 2018 Joel Duffy, Markievicz Pharmacy, Sligo with Tanya O’Toole, Head of Consumer Healthcare Ireland, Sanofi
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Awards The Irish Pharmacy
COMMUNITY PHARMACIST OF THE YEAR AWARD 2019 This Award seeks to recognise a community pharmacist who is defining the future standard of pharmacy practice by his or her professional practice and/or by advocacy in the pharmacy industry. Judges will be looking for those who demonstrate leadership and exemplifies the evolution of the pharmacy profession toward an expanded role in health care. The winner will be able to show significant contributions to the pharmacy industry overall resulting in meaningful improvements in the quality of patient care and improved delivery models and pharmacy’s role on the health care team. Applications are invited from both the independent and chain sectors. To be eligible, a nominee must have been practicing for at most 5 years. (Those working under the age of 30 should apply for the Young Community Pharmacist of the Year category. Student pharmacists should be nominated for the Life Pharmacy Student of the Year category.) Account will be taken of: Evidence of long-term, consistent dedication and outstanding achievements that have led to the advancement of the profession of pharmacy and public health Evidence of a large variety of skills, attributes and accomplishments Evidence of an individual strong in character, cumulative professional accomplishments and the ability to properly represent and model what pharmacy as a profession encompasses Evidence of an understanding the goals of pharmacy, and significantly contributing to how these goals may be achieved
Mike Walsh, Community Pharmacist of the Year 2018, Walsh’s Pharmacy, Fermoy
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Awards The Irish Pharmacy
CLONMEL BUSINESS DEVELOPMENT (CHAIN) AWARD 2019 Open to all pharmacies with more than 3 stores
The Clonmel Business Development (Chain) Award serves to recognise those who have displayed success in terms of sales, training, recruitment, customer service, product development or other areas of business development. Entries should demonstrate an innovative approach to creating new business, and outline the timescales, objectives and results of the initiative. Judges will look for a business initiative that stands out in terms of its scale, scope or approach. This award will credit the company that has demonstrated excellent levels of customer service backed by clear standards and adequate monitoring performance. Account will be taken of: Clear demonstration of an identified need and personal rationale along with details of the process of implementation from concept to design, planning and results Evidence will be displayed for plans for further research and development Evidence of a sound business plan, sales and marketing strategies Strong leadership skills with the ability to drive the business forward Innovation and ambition Clonmel Business Development (Chain) of the Year Award 2018 winners CarePlus Pharmacy Group. Pictured are Lee-Ann McCarthy, Head of Marketing, CarePlus Pharmacy, Barry Fitzpatrick, Director of Sales, Clonmel Healthcare and Breege McTigue, Head of Customer Engagement, CarePlus Pharmacy
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Awards The Irish Pharmacy
UNITED DRUG BUSINESS DEVELOPMENT (INDEPENDENT) AWARD 2019 Open to all pharmacies with less than 3 stores The United Drug Business Development (Independent) Award serves to recognise those who have displayed success in terms of sales, training, recruitment, customer service, product development or other areas of business development. Entries should demonstrate an innovative approach to creating new business, and outline the timescales, objectives and results of the initiative. Judges will look for a business initiative that stands out in terms of its scale, scope or approach. This award will credit the company that has demonstrated excellent levels of customer service backed by clear standards and adequate monitoring performance. Account will be taken of: Clear demonstration of an identified need and personal rationale along with details of the process of implementation from concept to design, planning and results Evidence will be displayed for plans for further research and development Evidence of a sound business plan, sales and marketing strategies Strong leadership skills with the ability to drive the business forward Innovation and ambition
Patrick Watt, Director of Sales & Marketing, McKesson Ireland and Amy Kieran, Pharmacist/Owner, Kieran’s Avenue Pharmacy – winner of the United Drug Business Development (independent) Award 2018
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Awards The Irish Pharmacy
INNOVATION AND SERVICE DEVELOPMENT (CHAIN) AWARD 2019 Open to pharmacies with more than 3 stores The Innovation & Service Development Award’s principal aim is to reward innovation within the community pharmacy sector. The judging panel will be looking for ways in which a project is both innovative and successful. This Award identifies individuals and teams working within multiple community pharmacies in Ireland whose ideas or inventions have, or could lead to, improvement in the patient experience in all areas of care throughout their community. Applications are sought from those demonstrating clear enthusiasm and commitment to the enhancement of community pharmacy in Ireland, exceptional quality above and beyond what is expected and an ability to overcome challenges in pursuit of goals. Account will be taken of: Activities that may involve pioneering new models or systems that improve pharmacists’ impact as members of the healthcare team; patient safety and outcomes; patient care in general and other professional development Development of a system or tool for pharmacy that will directly or immediately impact patient care or the profession and/or serve as an example or template for other pharmacy professionals to follow Measurable benefits of your initiative. Please use financial data wherever possible (percentages, rations, graphic images etc.), as well as other statistics to show how your project has bought added value, profits, customer satisfaction improvements, productivity increases or any other benefit relevant to this award category
Tom Concannon, Superintendent Pharmacist of Hickeys Pharmacy Group, winners, Innovation & Service Development (Chain) Award 2018
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Awards The Irish Pharmacy
JPA BRENSON LAWLOR YOUNG COMMUNITY PHARMACIST OF THE YEAR AWARD The JPA Brenson Lawlor Young Community Pharmacist of the Year Award recognises rising talent – those individuals who despite being in the early stages of their pharmacy careers are already demonstrating that they can make a difference to the pharmacy profession and the companies for whom they work and the communities they serve. This Award is open to pharmacists aged up to 30 at the date of entry submission, who are working within any pharmacy, multiple or independent, where their involvement has been greater than six months. It is the individual qualities that will be evaluated, rather than those of any of the projects worked on. Account will be taken of: Judges will want to see effective communication skills with both staff and customers Demonstration of a commitment to mentoring or other leadership activities Operation within their own pharmacy liaising with key staff members and management and developing key communication skills A dedication and commitment to furthering the profession into the future
Grace Grimes, Pharmacist, Meagher’s Pharmacy, winner of the JPA Brenson Lawlor Young Community Pharmacist of the Year Award 2018 with Jason Bradshaw, Partner, JPA Brenson Lawlor
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Awards The Irish Pharmacy
COMMUNITY PHARMACY TECHNICIAN OF THE YEAR AWARD 2019 It is evident that pharmacy technicians are playing an increasingly important supporting role as pharmacists are increasingly spending more time with patient consultations and engaging local stakeholders. The shift in emphasis from dispensing to healthcare provision has meant that the wider pharmacy team has to pull together – pharmacy technicians capture the essence of this in everything that they do. This Award will recognise the winner’s important contribution to the community pharmacy technician profession. Applications are invited from both the independent and chain sectors. The judges will be looking for those who can demonstrate promotion of the role of the Pharmacy Technician and those who continue to champion excellence through forward thinking and innovation. The winners’ achievements will be an inspiration to those pursuing innovative practice; to those striving to raise standards; and to pharmacists who, through their professionalism, provide models for others within pharmacy. Account will be taken of: Evidence of long-term, consistent dedication and outstanding achievements that have led to the advancement of the profession of pharmacy and public health Evidence of a large variety of skills, attributes and accomplishments Evidence of an individual strong in character, cumulative professional accomplishments and the ability to properly represent and model what pharmacy technicians as a profession encompasses
Lynsey Rigney, The Village Pharmacy Coolock, Community Pharmacy Technician of the Year 2018
Evidence of an understanding the goals of pharmacy, and significantly contributing to how these goals may be achieved
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AYA VITAMINS CATEGORY DEVELOPMENT AWARD 2019 The AYA Vitamins Category Development Award aims to recognise the specialist knowledge and expertise of pharmacies in areas such as first aid, derma skincare or vitamins, minerals and supplements. Running a successful pharmacy means much more than knowledge of top-selling products. The ability to optimise retail performance through a specific group of products managed as a distinct business unit shows an understanding and appreciation of the market and the ability to excel in these competitive times. Judges of this category will be looking for an identified need within the pharmacy, followed by details of the project implementation process from conception to resolution. The Award is seeking entries from those who can demonstrate the measurable benefits from a specific project or initiative and have added value, profits, increased productivity and customer satisfaction. Account will be taken of: Evidence of training, education and/or support initiatives undertaken by the pharmacist/pharmacy team Demonstration of benefits from a specific project Winners of the Uniphar Fixxa Category Development Award 2018, Jane Bruton, Supervising Pharmacist and Martina Vengrinova, CarePlus Pharmacy Group and Sarah Sambrookes, Head of Consumer, Uniphar Group
Examples of fresh thinking within category development for the enhancement of this sector within community pharmacy Ambition in improving performance, furthering knowledge and understanding of the market
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Awards The Irish Pharmacy
RB NUROFEN RAPID RELIEF OTC RETAILER OF THE YEAR AWARD 2019 This Award is open to those pharmacy businesses with more than 4 stores throughout Ireland
Customer purchases of OTC products have consistently risen, for many reasons. The convenience of treating a condition with an OTC product is appealing to the typically busy person, who seeks to avoid a lengthy and expensive GP visit in favour of meeting the demands of home and work. In addition, patients in the information age have an increased level of awareness about health. The over-the-counter market continues to thrive as manufacturers continue to think of new promotional and packaging ideas and as the general public take a greater interest in their own health and wellbeing. Pharmacies are increasingly witnessing heightened footfall as GP visits decrease. Pharmacy staff are the focal point for helping customers select appropriate OTC medicines, suggest diagnostic testing and accessory products and must be aware of when to refer individuals to the pharmacist. Knowledge of the market is essential; seasonal products and accessories; the use of displays and front of shop expertise and judges will want evidence of excellent merchandising strategies. Account will be taken of: Demonstration of identifying key promotional opportunities to add value for the customer such as health promotion events and displays A showing of continuous working with manufacturers and suppliers to plan yearly promotional calendars to meet pharmacy profit goals Implementation of innovative strategies to competitive pricing Examples of education for staff on new products and convenyance to customers as to efficacy and usage
OTC Retailer of the Year 2018 Jane Brennan, Brennan’s Life Pharmacy, Donabate
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LIFE PHARMACY’S PHARMACY STUDENT OF THE YEAR AWARD 2019 This Award serves to recognise the next generation within community pharmacy in Ireland. Life Pharmacy’s Pharmacy Student of the Year Award recognises and celebrates outstanding pharmacy students by showcasing their skills to the pharmacy profession. Judges will be looking for a pharmacy student who has made consistent, sustained and outstanding contributions toward pharmacy student participation on both a local and national level. Those who are able to demonstrate leadership abilities, advocacy for health system pharmacy, and a devotion toward community pharmacy are invited to apply. This category showcases the skills and abilities of some of Ireland’s outstanding pharmacy students to the pharmacy profession while also giving students a chance to apply their skills and be judged on them. Account will be taken of: Demonstration of performance through the academic year Engagement in extracurricular activities, such as participation in committees, or having launched an initiative to the benefit of fellow students Evidence of activities to promote the advancement of the profession of pharmacy Winner of the 2018 Life Pharmacy’s Pharmacy Student of the Year, Meabh Ryan, TCD pharmacy student and Gerard Coffey, Chairman of Life Pharmacy
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Outstanding academic excellence / achievement together with outstanding achievement / contribution as an individual to student life
Awards The Irish Pharmacy
COMMUNITY PHARMACY TEAM OF THE YEAR AWARD 2019 This Award will be given to the community pharmacy team that demonstrates the best combination of team spirit and enhancement of patient care at all levels. The judges will be looking for those who encourage and support each other and those who have collectively demonstrated innovation and forward thinking. The key to any successful pharmacy is Teamwork and this award recognises the power and potential of a focused and unified approach to healthcare initiatives. Teams can be based within one organisation or spread over multiple organisations; but they must comprise individuals working towards the same objective or goal. Account will be taken of: How the team has demonstrated their ability to deliver clear benefits to patients; and/or staff members through working together efficiently and effectively
McCartans Pharmacy Team Donaghmede, winners of the 2018 Community Pharmacy Team of the Year Award
How the team has worked together to achieve its objectives over the past twelve months Projects that the team has successfully managed which demonstrate excellence in qualty, innovation, productivity and prevention A clear display of the principles underpinning their success as a team
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Awards The Irish Pharmacy
BABY & CHILD HEALTH PHARMACY OF THE YEAR AWARD 2019 This Award celebrates the application of innovation and dedication within the children/baby market in pharmacy. It will recognise an outstanding pharmacy store, project or initiative where creative thinking, sound research and team working have combined to achieve real service development in this specific area. Judges will be looking for the store, or team that have pioneered an initiative providing an excellent, compassionate standard of service within the children/ baby market to this patient group. It might be a model that ensures a high level of continuity of care in this area, or a unique way of working or providing care to this population. Account will be taken of: Clear demonstration of an identified need and personal rationale along with details of the process of implementation from concept to design, planning and results Evidence will be displayed for plans for further research and development Evidence of the process by which the project was developed and implemented Evidence of impact on women and families within the local community
Winner of the 2018 Nurofen for Children Baby Health Pharmacy of the Year Sheena Mitchell, Milltown Totalhealth Pharmacy
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Awards The Irish Pharmacy
KRKA COUNTER ASSISTANT OF THE YEAR AWARD 2019 Pharmacists may grab many of the headlines, but alongside each is the remainder of the pharmacy team, all of whom play a critical role in the success of the pharmacy and the services it provides. Perhaps you are a counter assistant, or know of a counter assistant who has helped recruit patients to the pharmacy’s services, delivered health promotion activities, or forged links with the local community. Or you/they might have improved safety or efficiency in the dispensing process, taken on delivery of clinical services or management responsibilities, or mentored colleagues. The KRKA Counter Assistant of the Year Award recognises excellence in knowledge and service to retail customers. Nominations for the category can be made through self-nomination, by colleagues or by pharmacy business owners. Judges will be looking to reward those who bring something extra to the consumers experience of the pharmacy setting within a community. Account will be taken of: Clear demonstration of how the nominee/counter assistant has successfully placed customer care at the forefront of their pharmacy The details and rationale for any specific initiatives developed by the nominee for customer care Levels of excellence displayed above and beyond that expected from a counter assistant role Clear evidence of team working and excellent communication between the individual, their peers/colleagues and their patients and local community
Winner of the 2018 KRKA Counter Assistant of the Year Award Phil Cahill, Adrian Dunne Pharmacy, Trim
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Awards The Irish Pharmacy
GSK SELF-CARE AWARD 2019 This Award recognises community Pharmacy’s commitment to tackling health inequalities and serves to reward achievement in the development and implementation of health promotion, self-care and community wellbeing strategies/initiatives. It is designed to encourage excellence in the production and dissemination of accessible, well-designed and clinically balanced patient support. The Award will be presented to the team or individual who can demonstrate a significant positive impact on the experience of those who use Pharmacy services. This may be through campaigns, promotions or initiatives which have identified a need within the community to address certain health issues. Account will be taken of: Evidence of long-term, consistent dedication and outstanding achievements that have led to the advancement of the profession of pharmacy and selfcare Evidence of an individual strong in character, cumulative professional accomplishments and the ability to properly represent and model what pharmacy as a profession encompasses Rebecca Barry, Supervising Pharmacist and Maria McBrearty, Pharmacy Manager, LloydsPharmacy Castletroy, winners of the GSK Self-Care Award 2018 with Bryan Dunne, GSK Customer Business Manager
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Evidence of an understanding the goals of pharmacy, and significantly contributing to how these goals may be achieved
Awards The Irish Pharmacy
MCLERNON COMPUTERS EHEALTH & INNOVATION (INDEPENDENT) AWARD 2019 Open to pharmacies with less than 3 stores An adapted category for long-standing sponsor, McLernon Computers, the eHealth & Innovation Award for an independent pharmacy seeks to recognise and reward those that are showcasing digital health innovations, solutions and applications within their pharmacy business. eHealth, when applied effectively, delivers more personalised 'citizen-centric’ healthcare, which is more targeted, effective and efficient. This award category is aimed at those embracing the integration of Information and Communication Technologies in the world of healthcare, encouraging forward and leading edge thinking in the growing sector of eHealth. The judging panel will be looking for ways in which a project is both innovative and successful, identifying pharmacy individuals and teams working within the independent pharmacy sector in Ireland whose applications have, or could lead to, improvement in the patient experience in all areas of care throughout their community through the use of eHealth. Account will be taken of: Focus on resources and organisational focus on eHealth as well as initiatives implemented Activities which may involve introducing new models or systems that improve pharmacists’ integration as members of the healthcare team Examples of impact and benefit for the end-user/ patient care Demonstration of measurable benefits of the initiative (Please use supplementary data wherever possible, as well as other statistics to show how your project has bought added value, profits, customer satisfaction improvements, productivity increases or any other benefit relevant to this award category)
Winners of the 2018 McLernon Computers Innovation & Service Development (Independent) Award Joanne Sheridan, Staunton’s Link Pharmacy pictured with Robin Hanna, Sales Director, McLernons Pharmacy
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Awards The Irish Pharmacy
SUPERINTENDENT PHARMACIST OF THE YEAR AWARD 2019 Superintendent pharmacists have overall responsibility for setting out the standards and policies for the provision of pharmacy services by their organisations. The role of Superintendent Pharmacist is a key position carrying full time responsibility and accountability. This Award will be looking to recognise those individuals who are serving as key drivers for the implementation of enhanced and excellent pharmacy care within the community they serve. Judges will be looking for applications from those that are focused on establishing a framework for achievement of a high quality, safe and consistent service for the benefits of the patient, as well as facilitating the development of the professional role of the pharmacist. Account will be taken of: Applications are invited from independent and multiple Superintendent Pharmacists who can demonstrate one or more of the following: Understanding patient needs when delivering healthcare in the community Examples of great patient experience and care, innovation and ambition Best practice in delivering professional services and patient reviews Encouragement of staff education in patient health and wellbeing advice Superintendent Pharmacist of the Year, 2017 Eugene Renehan, Superintendent Pharmacist, Meagher’s Pharmacy Group
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Strong leadership skills with the ability to drive the business forward
Management of Diabetes: Pharmacistâ€™s Role There are approximately 20,000 adults living with Type 1 diabetes in the Republic of Ireland. Long-term good health depends, perhaps more than with any other long-term condition, on full engagement of the person with Type 1 diabetes in life-long day-to-day self-management.
owever, current evidence shows the care of people with diabetes varies across Ireland. Care may be limited, unstructured and ad-hoc in some locations with limited access to specialist expert diabetes opinion in secondary care. Only 42% of hospital diabetes services are currently offering adults with uncomplicated Type 1 diabetes the recommended six monthly review appointments. Instead many patients are offered only infrequent appointments focused on annual review which is some cases are not even every calendar year but much longer. According to Diabetes Ireland, current services are not supportive of the person with Type 1 diabetes. In order to support the Type 1 diabetes community, the health
service needs to provide informed, expert support, education and training as well as a range of other services and interventions for the prevention and management of long term health problems. Community pharmacists play a key role in the delivery of quality diabetes care. They are the most appropriately qualified to support patients on how to use their medicines to manage their condition. And they can advise on recommended lifestyle and dietary interventions. Studies show that the involvement of pharmacists in diabetes management improves adherence to treatment regimens. Unfortunately, lack of public awareness means that many people with the condition donâ€™t take advantage of the services offered by community pharmacies.
Pharmacists and their teams adequately educated and knowledgeable on the condition, can avert hospital admissions and distress for those with diabetes by being able to resolve queries related to lifestyle issues, self-care and management, compliance and proper injection techniques. For those who are diagnosed, pharmacists are able to provide support and advice about monitoring glucose levels and how to manage out-of-range levels, including developing an action plan for what to do if sugar levels go too low. Pharmacist can help patients select the most appropriate hypoglycaemic management strategy on an individual basis. Pharmacists can advise on an appropriate diet and exercise routine to compliment medication management in treating
diabetes. This can be especially useful in underserved areas where access to nutritionists or dieticians may be unavailable. The number of treatment options for diabetes has increased substantially over the past few years, and pharmacists are best positioned to help patients understand the fundamentals and intricacies regarding the medication as well as helping them understand which medications may be best suited for them. Pharmacists can also help guide patients through the management of adverse effects, knowing when and how to treat these so that therapy can be continued and when it might be better to switch to an alternative treatment regimen. For patients requiring insulin, the pharmacist can help instruct the patient on how to
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appear reasonable. It is over 20 years since the publication of the Diabetes Control and Complications Trial (DCCT), which proved beyond doubt that intensive glucose control in people living with Type 1 diabetes reduces the risk of microvascular and neuropathic complications. Realising this goal remains challenging at the level of the individual patient and across the health service, including the community setting. Effective Management The aim of treatment is to try to maintain glucose level to as near a “non -diabetic” range as possible. In general terms this means to aim towards 4 -7 mmol/l before meals, and around 8 mmol/l if testing 2 hours after meals. This can be difficult for some at times, and readings may vary depending on carbohydrate intake, exercise and many other daily factors.
administer the medication, as well as answer common questions and concerns. Dealing with the Diabetic Despite the therapeutic diversity, despite on-going innovations, and despite ranking high on the clinical, political and public heath agenda, diabetes still accounts for about 26,000 additional deaths a year. People with diabetes are about 32% more likely to die prematurely than their peers in the general population. Fortunately for the millions of people with diabetes, recent research is changing the way we view this common disease and raises the prospect of improved diagnosis and treatment.
the avoidance of hypoglycaemic events. It has been clearly shown that maintaining good glycaemic control not only reduces diabetes related complications, but is also associated with a better quality of life for people with type 1 diabetes (children, teenagers, young and older adults). Despite an awareness of the importance of group education, only 409 adults with Type 1 were recorded as having attended such programmes in Ireland in 2016, with only 159 having attended a programme which meets international standards.
The prevalence of Type 1 diabetes, an auto-immune condition, is on the rise and is typically diagnosed in childhood. People with type 1 diabetes account for approximately 14,000 – 16,000 of the total diabetes population in Ireland i.e. 10-15% of the population of people living with diabetes.
In June of last year, National Clinical Effectiveness Committee (NCEC) in Ireland launched a new guidelines aimed at improving the quality and safety of treating Type 1 diabetes. This guideline was the first to be developed in Ireland using the UK’s National Institute for Health and Care Excellence (NICE) contextualisation process; whereby a recent NICE guideline is adapted for use in another country.
Type 1 diabetes is associated with major short - and longterm very serious medical and psychological emergencies and complications. The management of Type 1 diabetes is challenging, intrusive and on-going for both the individual and his/her family. The person with diabetes must adhere to a complicated management regimen involving multiple daily insulin injections or learn to use insulin pumps, frequent daily monitoring of blood glucose levels, and adjustments in diet, insulin and exercise and
Dr Kevin Moore, Chair of the Guideline Development Group says, “Type 1 diabetes care requires a multidisciplinary approach to care that empowers patients to successfully manage this life-long condition. Current evidence shows variation in how care is delivered across Ireland and so this NCEC National Clinical Guideline will standardise the approach with a special focus on patient education and clinical review. Overtime, this will mean better outcomes for patients with Type 1 diabetes.”
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Clinical and Financial Impact The complications of Type 1 diabetes can result in disability: including vision loss, kidney failure and foot ulceration leading to amputation, as well as premature heart disease and stroke. The morbidity associated with these complications can have a devastating impact on quality of life and generate a significant cost to the state.
This management takes time and practice and requires that you work closely with the diabetic patient in guiding them to maintain the best possible blood glucose control. Hyperglycaemia or Hypoglycaemia can be caused by high or low glucose levels. High blood glucose levels, also known as Hyperglycaemia or Hyper. Diabetics will notice that their blood glucose level may be higher if they:
A systematic review and meta-analysis which included studies with people living with type 1 diabetes in Ireland showed the prevalence of diabetes complications ranged widely depending on study population and methodology used (6.5–25.2 % retinopathy; 3.2–32.0 % neuropathy; 2.55.2 % nephropathy) (Tracey et al, 2016). However this review highlighted a number of limitations in interpretation of available data due to inconsistencies in reporting, limited availability of objective data and standardisation in diagnostic criteria (Tracey et al, 2016). Another Irish study showed the average glycaemic control in a population of young adults (18–25 years old) with type 1 diabetes was poor at 81mmols/mol and diabetes related complications were present in 32% of this young adult population (Casey et al, 2014).
• Are not taking enough insulin
Data from the UK estimates 10% of the entire health budget is spent on diabetes and related complications, this is projected to rise to around 17% in 2035/2036 (Hex et al, 2012). The true costs in Ireland are unknown; a similar estimate to the UK would
• Leave too long between meals
• Miss or forget to take their insulin ( or take a lower amount in error) • Eat more carbohydrate foods than usual • Are less active than usual • Are under stress • Have an illness e.g cold flu, infection • Sometimes it may be difficult to find a reason Low blood glucose levels, also known as Hypoglycaemia or Hypo. Diabetics may notice that their blood glucose may go to low (ie. Under 4 mmol/l) if they: • Take too much insulin • Eat less carbohydrate than usual
• Do more activity than usual • Following alcohol (which may not occur until a few hours later) • Sometimes they may not find an obvious reason
People with diabetes tend to “get to know” what situations they may be likely to experience a HYPO, and learn to try avoid or pre-empt these situations where possible. Symptoms may include: • Feeling sweaty or cold • Trembling or feeling weak • Feeling irritable upset or angry • Inability to concentrate • Drowsy or difficulty in waking up It’s important that they learn to recognise their particular warning signs and understand how to take appropriate action promptly. Hypos can happen in minutes and need to be treated immediately. Education Points, Advise: • Be aware of hypo symptoms and treat as necessary • Always carry quick acting carbs • Inform friends and colleagues about diabetes, the need to take insulin, test glucose levels and very importantly what to do in the event of a hypo event • Carry diabetes identification Therapies & Techniques There are 4 broad categories of Meters available for the treatment of diabetes. 1. Basic Glucose Meter - A basic meter provides a one-off reading of blood glucose. 2. Advanced Glucose Meter & App - Advances in smart phone technology allow a blood glucose meter to integrate with a smartphone app to help the management of diabetes. Blood glucose readings can be automatically uploaded to a smart phone and over time, results may create meaningful insights into what affects the users blood glucose levels. Glucose sensors are small circular devices, worn on the body and they measure the glucose levels in the fluid that bathes and surrounds body cells (called Interstitial fluid). They do not measure glucose levels in the blood as the sensor is not placed in the blood stream. Blood glucose readings and fluid glucose readings will be close but won’t match and there will be a greater difference when glucose levels are changing more rapidly like after eating, after taking insulin and during exercise. Glucose Sensor and Reader These consists of a small disposable glucose sensor worn on the skin for up to 14 days and a wireless reader device. The user just physically scans the reader
device over the sensor to see their fluid glucose readings displayed on the screen along with the latest eight hours of glucose data and a trend arrow showing if glucose levels are going up, down or changing slowly. It stores up to 90 days of glucose data. The data is not being continuously sent to the reader device and it does not have alarm settings. Continuous Glucose Monitoring Systems (CGMS) - A CGMS is a small disposable sensor placed under the skin that can be worn for up to 7 days. The sensor is connected to a transmitter and fluid glucose readings are transmitted wirelessly to a smart phone or hand-held receiver device or an insulin pump where you can see the data displayed on a screen with a trend arrow. From the arrow, you can see if glucose levels are trending up or down. A CGMS gives a constant read out of glucose levels and it can include an alarm feature that lets patients know if glucose levels are too high or too low. Many factors need to be taken into account when assisting the diabetic with their choice of meter: • size, memory of meter, ease of use, downloading facilities • amount of blood required, calibration, strip stability, range of results and factors influencing results • option of checking for blood ketones An Insulin Pump is another way of delivering insulin rather than using a syringe or pen. It is a small programmable battery-powered device that is worn externally on the body. An insulin pump contains a syringe of insulin which is changed by the user every 2-3 days. The syringe of insulin is placed into the pump and it is attached to the body via a narrow tube (infusion set) and a small plastic cannuale that is placed under the skin. Insulin injections are not required by the pump user except for a situation where the pump is not working. The pump weights approx 3 ozs and measures 7 cms X 5 cms and is usually worn on a belt or carried in a pocket. It is the same size as a pager and is worn in a similar manner. Insulin pump therapy has become popular as part of diabetes management in recent years and there are advantages and disadvantages to it. In general, the pump is recommended as an option for people with Type 1 diabetes who, despite multiple daily injection therapy have not
been able to maintain a A1c level without experiencing repeated and unpredictable episodes of hypoglycaemia. The sensors would only be sanctioned based on clinical need e.g repeated and unpredictable episodes of hypoglycaemia. The pump delivers fast acting insulin at a basal rate and insulin can also be delivered by the user when eating or to correct a high blood sugar (bolus of insulin). The basal rate of insulin can be set at several different rates over a 24 hour period, depending on the person’s insulin requirements. There is a temporary basal rate function which can be set at a reduced or an increased rate for a precise period of time to allow for exercise or times of illness. Insulin pumps are a very precise way of delivering insulin as a fraction of a unit of insulin can be delivered reducing the risk of hypoglycaemia. Ideally a person on a pump should be carbohydrate counting so they can give a precise amount of insulin for the carbohydrate they are eating. Also each person has an individual ‘insulin sensitivity’ i.e. they know the effect that 1 unit of insulin has on their blood sugar. In that way they can take a precise ‘correction bolus’ of insulin to bring their blood sugar back to the target range they want. Important facts to consider before recommending a Pump: • They will be attached to the pump continuously, it can only be removed for up to 1 hour. • Only fast acting insulin is used in the pump • There is an increased risk of DKA if action is not taken to correct high blood sugars promptly • Frequent blood glucose monitoring is essential to determine dosage and ensure that insulin is delivered • The pump does not measure blood glucose levels or determine the insulin dose to be delivered • To decide how much insulin is needed, a certain level of technical and numerical skills are required An insulin pen, so called because it looks likes like a writing pen, is a carrier for Insulin and it is used to set the dosage and to inject the insulin. Pens are either disposable or refillable and both the disposable pens and cartridges for refill contain 3mls of insulin (100 units per ml).
The pen consists of a dial at the end for selecting the required dose. A needle is placed on the top of the pen and there is an injection button at the other end of the pen which is pushed to administer the required dose. All pens require a disposable needle which screws onto the top of the pen.
Diabetes related amputation on the rise Adults of all ages, who have had diabetes for more than 5 years need to ensure they have a full and proper foot assessment by a podiatrist or other appropriate healthcare professional at least once a year. People with diabetes have special reason to take good care of their feet. Long term high blood glucose levels may make feet susceptible to injury and infection. This is because the protective sensation in the toes or feet, the “pain alarm system” may slowly disappear due to with long term exposure to high blood glucose levels. The latest data, obtained by Roisin Shortall TD, shows that 547 people with diabetes underwent a lower limb amputation in 2017, accounting for 63% of the total procedures carried out in the year. This is the highest number of diabetes related lower limb amputations carried out in a calendar year over the past 4 years. There were a further 2,081 people with diabetes hospitalised requiring foot ulceration treatment spending on average 10 days in hospital for treatment in 2017. With such high numbers, people with diabetes should be encouraged to be proactive in having an annual foot assessment which will identify any problems and allow treatment to be undertaken early thus preventing more serious problems from occurring. Recommendations are that people should examine their feet daily and be on the lookout for small cuts, changes in skin colour and temperature, red areas and swelling. They also have to check they have continuing sensation in their feet and be alert to signs such as prickly pain in the feet, numbness and peculiar sensations such as a feeling of walking on cotton or of wearing tight socks. This is important as, without a pain alarm system, injuries and poor fitting shoes may go unnoticed.
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Automation in the Future of Pharmacy
he emergence of automation within the community pharmacy setting has been gathering pace for some time. The idea of using robots in the dispensing of medicines is not a new one. Automated dispensing devices have been used widely in hospitals around the world since the mid-1990s as a way of reducing medication errors, improving patient safety and decreasing costs. Over the last decade these devices have expanded into community pharmacy settings as financial pressures have driven the search for efficiencies. Automated systems can reduce the error rate in dispensing medicines, but there appears to be a continuing ‘fear’ from many community pharmacies regarding their use. Many of those who have been actively embracing automation for some years believe this can be put down, in large, to confusion and a lack of knowledge about factors such as safety and cost. In this article, we take a look at some of the most common myths surrounding the automation market in pharmacy. Counting the Cost There has been pressure for community pharmacies to increasingly embrace automation for some time now, not just in Ireland, but further afield across the UK. Reports suggest
that nearly 70% of community pharmacies in Denmark use automated or robotic dispensing technology but this figure drops to between 30 to 40% across the rest of mainland Europe. Many pharmacies don’t understand the benefits that pharmacy robots can bring, including time and cost saving efficiencies. As more and more pharmacists are facing pressures, an ageing population, budget cuts and medicine shortages. The advent of the Falsified Medicines Directive is another challenge, which is very pertinent today. Therefore, it’s crucial that pharmacists consider the benefits of incorporating new technology to increase efficiency. Automated systems are expensive to buy so may not be cheaper over the short term, particularly when you consider the average wage for
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pharmacists is relatively modest. However, new developments in automation have brought the costs of software and machines down. Devices that were once off-limits to all but the largest pharmacies are now priced so that smaller facilities can afford them. Increased artificial intelligence and machine learning facilities, combined with the lower cost of automated systems, have put automation within reach for even smaller pharmacies. And many leaders in this field believe the cost savings to be made in the long-term means automation is an investment worth making. Robots replacing Staff Another concern voiced by many, is that robots installed within the pharmacy means job cuts for pharmacy staff. This is not the
case, often robots actually free up the time of pharmacists and technicians which can then be spent dealing with customers, consulting and offering advice on complaints and medications. Even the most experienced pharmacist or technician is slower than a machine. Automation allows pharmacies to fill more orders more quickly while freeing up staff to do essential tasks that can’t be automated, such as engaging face to face with patients. Accuracy is a major concern in the pharmacy world. Even the most seasoned or careful human can make mistakes. For many medications, an error in dosage can cause adverse effects or even kill a patient. Automating the process of measuring out medication greatly reduces the chances of error.
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Big Data Big Data and Artificial Intelligence (AI) play a key role for the future of healthcare in Europe, according to a new report It has been revealed that European community pharmacists consider new, innovative and automated technologies a useful tool to support and complement their expert professional advice to patients and to deliver more efficient, sustainable and high-quality pharmacy services. Community pharmacists have the infrastructure and expertise to deploy Big Data and AI in practice: they already use digital services on a daily basis (e.g. dispensing ePrescription, checking for medication interactions via Electronic Health Records, promoting adherence via mobile apps) to provide better care and monitor patients’ conditions. Humans may make errors when contacting patients about their prescriptions or when following security protocols for drugs like opiates. For example, a pharmacy technician can leave too much information in a voicemail for a patient, while automated calling programs will consistently only verbalize information programmed by the pharmacy. For controlled drugs, the staff member may forget to log out a medication. Locked security cabinets can reduce this by requiring specific dispensing information before allowing access to the medication. Robin Hanna is Sales Director at McLernon Computers. He says the growth in the automation market is evident. “We have noticed the growth in the automation market over the past number of years, and have dedicated valuable development time to ensure that our customers can have a seamless integration between their MPS dispensing systems and their choice of robot,” he says. ‘At McLernons, we aim to help our customers run their businesses as efficiently and effectively as possible, and that is why we see providing interfaces with the various robotic and automated systems, as well as developing business IT tools, as an essential part of our support for community pharmacists and their businesses. “To date, we have written interfaces with ARX, Consis, Tosho, Robotik, HD Medi, Synmed,
Clover 51 and Medinoxx and I am sure these numbers will increase as new technology comes onto the market. Embracing Automation locally “We put a lot of time and effort into ensuring that there is a smooth interface between an MPS dispensing system and the robot, in order to maximise its functionality and deliver the benefits that they can bring to the dispensary. Our customers invest huge amounts of money in their automation and we want to ensure that they obtain optimal outcomes.” Pharmacies are quickly learning that they can’t afford not to automate at least some tasks. Automation increases a pharmacy’s efficiency while dramatically reducing its rate of error. It frees up human pharmacists to perform important tasks like interacting with patients face to face, which can’t be delegated to a machine. As the costs associated with automation continue to drop, more pharmacies are realising that they can’t afford to put off automation any longer. As new developments in automation emerge, pharmacies will become more efficient, cleaner and safer Cahir Pharmacist Dermot O’Brien of O’Brien’s Pharmacy has been embracing the introduction of robotics to his pharmacy.
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Dermot installed the Tosho machine early in 2018 to ease the pressure on manually filling the trays for his nursing homes. Despite being slightly apprehensive in the beginning, both Dermot and all of his pharmacy staff love the working with the Tosho, and they are now continually growing this aspect of the business with the aide of the Tosho. Tosho has a long standing history manufacturing automated solutions for hospital and community pharmacies since its inception in 1971. Renowned globally for market leading technology and the reliability to go with it, Tosho automated medicine pouch packing solution can increase patient safety while lowering labour costs. Dermot then installed the Pouch Inspector in January 2019 with the aim to reduce the pharmacists checking time from 3 days per month to 3 hours. He also made the switch from Helix to McLernons last year hasn’t looked back. Robin Hanna continues, “We were delighted to work with Dermot and his team in Cahir when they transitioned across to McLernons with their Tosho robot. Our engineers and trainers, working in tandem with Tosho, and Dermot and his team, ensured a seamless installation which has been working very successfully.”
A position paper, published by The Pharmaceutical Group of the European Union (PGEU) outlines the main opportunities and challenges of the digital transformation in healthcare. PGEU Secretary General, Ilaria Passarani, states, “To maximise the benefits of Big Data & AI in healthcare it is necessary to involve community pharmacists as experienced users of digital health tools in the formulation of digital policies at local, national and European level as well as in the development of guidelines and methods on the sharing of Big Data. “It is also important to facilitate the production of Big Data in healthcare, ensuring interoperability and linking electronic health records with e-Prescribing systems. Community pharmacists should be allowed to update electronic health records, if needed, to identify and address potential medication and patient safety-related issues. AI should be used also to enhance collaboration among health professionals serving the same patients and to promote the integration of primary care systems.”
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Strategy highlights Cancer Challenge “Much progress has been made since the launch of the (Cancer) Strategy last year. I know that the work being done in implementing the Strategy is making a real difference in the prevention and early detection of cancer, while ensuring that the supports are in place for those living with and beyond a cancer diagnosis.” Professor M John Kennedy, Chairman, National Cancer Strategy
These were the words of Minister for Health, Simon Harris T.D as he launched the first implementation report on the National Cancer Strategy 2017-2026. The report was launched on World Cancer Day and 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. Scale of Impact With 170,000 people living with and beyond cancer in Ireland, the scale of the impact of cancer here is clear. Chairman of the Strategy, Professor M. John Kennedy says, “In this Strategy we map a route for cancer care over the next decade. However, given the accelerating rate of progress in the cancer field, the increasing recognition of the degree of complexity of cancer cases and the ten year Strategy period, issues will be addressed incrementally as short, medium and long-term goals. For example, immediate needs might involve addressing deficiencies in specialist cancer nursing and strengthening the role of the NCCP, while the development of comprehensive electronic patient records might be seen as a medium-term issue. Also, the centralisation of cancer surgical services, commenced several years ago, must be completed as expeditiously as possible. “However, it is more difficult to define the challenges which will arise in the later years of the Strategy period and so is proposed
that the recommendations of the Strategy will be reviewed towards the end of 2021 to ensure that our aims and direction are appropriate to deliver optimum outcomes for patients. “As is the case across the Strategy, I strongly believe that the most strenuous efforts must be made to target more deprived populations in cancer prevention and early diagnosis interventions. There is incontrovertible evidence of the enormous impact of socioeconomic status and deprivation on death rates from some cancers in Ireland. The causes are multifactorial, ranging from high smoking levels, and poor diet to inadequate access to timely diagnostic services. Apart from being the just approach, this represents the most effective way to ensure future optimal value for money for the health service.” The Need for a Strategy The percentage of deaths attributable to cancer has risen from 20% in the 1980s to over 30% at present. At the same time, there are over 150,000 cancer survivors in Ireland now and a greater focus on the increasing numbers living with and beyond cancer is required. Many advances have been made in cancer control in the past decade. The previous strategy, A Strategy for Cancer Control in Ireland (2006), led to the establishment of designated cancer centres and the reform of how cancer is diagnosed and treated. The National Cancer Control Programme, established in 2007, has led on the development of cancer services, such as
rapid access clinics to improve early diagnosis, advances in hospital-based treatment and developments in more specialised areas such as hereditary cancer services. Other developments include the expansion of cancer screening and an emphasis on healthier lifestyles. Smoking cessation efforts have increased and the rate of daily smoking in the population over the age of 15 has now fallen to below 20%. However, many challenges remain. Increased demand has led to capacity and resourcing issues, particularly in relation to staffing. There is now an increased awareness and demand for additional support for cancer patients after diagnosis, including survivorship programmes and psychosocial services. Greater integration with primary care and local services is required to ensure seamless patient pathways before, during and after treatment. Cancer prevention will be a cornerstone of this Cancer Strategy as it offers the most cost-effective, long-term approach for cancer control. The proportion of cancer incidence attributable to modifiable lifestyle and environmental factors is estimated to be in the 30% to 40% range. Of these risk factors, smoking has by far the biggest impact and, in implementing this Strategy, the aim is to work towards the goal of making Ireland tobacco-free by 2025. Efforts also need to be increased, says the Strategy, to reduce the number of avoidable cancers through the promotion of healthy lifestyles, in areas such as improved diet, more exercise and reduced alcohol intake. Prevention measures will be integrated with the overall health and wellbeing initiatives under the Healthy Ireland programme. Reducing health inequalities is a priority of this Strategy, as lifestyle risk factors generally follow social, deprivation, gender and
age patterns. Health inequalities are also associated with poor symptom awareness, delayed presentation and low uptake of services, including screening. Detecting and diagnosing cancer early is a critical step in reducing mortality as a result of cancer. Efforts will continue to ensure that people take up the offer of cancer screening when invited through the BreastCheck, CervicalCheck and BowelScreen programmes. Broadened aged-based cohorts are envisaged for both BreastCheck and BowelScreen. Further improvements in overall survival rates will require an emphasis on increasing the proportion of patients diagnosed at an earlier stage of their disease. Early diagnosis is influenced by many factors. Public and health professional awareness of the importance of early presentation is critical, and is complemented by clear, evidence-based GP referral guidelines, clear pathways to specialist care and timely access to diagnostic services. This Strategy sets out ways to strengthen the care pathway to diagnosis through Primary Care, and to provide additional diagnostic capacity for GPs, guided by referral criteria. Prevention and Early Diagnosis highlights include: • legislation on standardised retail packaging for tobacco; • the passage of the Public Health Alcohol Act 2018; • the integration of cancer prevention into the messaging under the Healthy Ireland Initiative; • progress towards a national skin cancer prevention plan; and • the uptake rates for cancer screening. Highlights in Treatment and Survivorship include: • new posts in medical and surgical oncology; • the commissioning of 2 new linear accelerators in St Luke’s Hospital;
ur cancer types make up more than half of all newly diagnosed cancers (excluding non-melanoma skin cancer) - breast,
orectal, lung, 76 and melanoma in women (56%), and prostate, colorectal, lung and melanoma in men (57%) (Figure
Cervical Smear Delays
Figure 2.1 Percentages of the common cancer types, 1994-2014 Percentages of the common cancer types, 1994-2014 Female
ALL OTHER INVASIVE
ALL OTHER INVASIVE
5% 10% MELANOMA
• the progress of construction work on a new radiation oncology centre in Cork University Hospital towards completion in Q1 2019;
• establishment of a Cancer Patient Advisory Committee.
prevented, and to continuous improvements in the treatment and follow-up services available to patients with cancer.
The Interim Director General of the Health Service Executive (HSE) has told an Oireachtas committee that she is concerned at the length of time being taken for reporting on cervical smear checks. Anne O'Connor told the Oireachtas Health Committee that the HSE was actively trying to identify possible solutions that will help reduce the waiting times, which she said were causing a lot of anxiety for women. The CervicalCheck screening service has a backlog of around 78,000 slides to examine, and it is also taking up to 27 weeks to provide reports on the cancer checks. It takes an average of 93 days for laboratories to report on smear checks.
“The challenges facing us in cancer are significant,” added “The past year also brought Minister Harris. “The recent significant challenges with regards annual report of the National • publication of a Model of Care to cervical cancer. We will take a for Oral Anti-Cancer Medications Cancer Registry indicated that Ms O'Connor told the committee number of very important steps approximately 22,640 cases that the HSE had worked with • the commencement of the this year towards achieving our (excluding non-melanoma skin Introduction of new cervical roll-out of a National Cancer goal of effectively eradicating this cancers and non-invasive cancers) cancer test ‘held up by backlog’ Information System; cancer.” said the Minister. are diagnosed each year. While existing private providers, other e number of cancer cases has been increasing by about 3% a year since 1994, but the age-standardised incidence projections indicate that the • the progress being made by private providers and public The Implementation Report 2018 number of people with cancer Working Groups Survivorshipcancer at any given age, has been increasing e, a measure of the risk ofondeveloping by only can be found at: about 1% a year (Figure service providers in other will increase significantly with and Psycho-Oncology; countries to try and grow the our downwards increasing andover our ageing ; Table 2.2). Trends in death rates have been the same period (by 1.5% per year in men and 1.1% https://health.gov.ie/blog/ laboratory capacity. • the appointment of a National population, we have a pathway laid publications/ncs-implementationyear in women average). There are a number reasonsthat why rates have been increasing slightly, Clinical on Lead for psychoout in theofStrategy willcancer lead incidence report-2018/ She said that last year saw to many potential cancers being oncology; and uding increases in risk factors such as obesity, alcohol consumption and sun exposure and the impact of screening. an increase of around 90,000 women seeking smear tests, ch of the increase in the number of cancer cases and deaths is attributable to the growth in the population over as a result of the offer of free repeat screening. years of age; 62% of male patients with cancer and 53% of female patients during 1994-2014 were aged over 65
3. Trends in Cancer Incidence
Investment needed in diagnostics
ure 2.4). The Irish Cancer Society has responded to the release of the National Cancer Strategy
Implementation by calling for the provision of additional resources for diagnostics, as a matter of priority. Despite some early progress, the Society has said the Department of Health and HSE are falling behind on some key targets. Averil Power, CEO, Irish Cancer Society
Chief Executive of the Irish Cancer Society, Averil Power says, “Unfortunately for patients, many are not getting diagnosed within the timelines set out in the strategy. This can cause significant additional stress and worry for patients, often with acute symptoms, at a vulnerable time. We need continued investment in diagnostics, so that patients with worrying symptoms can be seen as quickly as possible.” The Society says that this comes despite improvement initiatives underway in the National Cancer Control Programme. “Early diagnosis is hugely important and it can mean the difference between life and death.
Ms O'Connor said that the HSE was also working to develop a national cervical screening laboratory, in conjunction with the Coombe Women and Infants University Hospital. The delay in examining smears at the CervicalCheck screening service has lengthened further, with women now waiting up to 27 weeks for test results. Testing laboratories are taking an average of 93 days to report on smears.
As such, we are disappointed that referral criteria for patients with suspected cancers that aren't assessed at Rapid Access Clinics, have not been developed by the 2018 deadline. ” The Society welcomed some of the progress made in meeting targets to date, especially with regard to patient involvement. “Overall, it is clear that there is a
need for sustained and increased investment over the course of the rest of the Strategy so we can not only stop people getting cancer, but ensure that more people survive and have a better quality of life. Currently, we are well off meeting the target of being in the top quartile for survivorship in the EU, and the Irish Cancer Society will continue to advocate for world-class services for patients,” Averil added.
The number of women seeking smear tests grew last year to 370,000, from 280,000, according to Ms O’Connor. The increase was prompted by a decision by Minister for Health Simon Harris to offer women repeat smears if they had concerns in the wake of the controversy over the CervicalCheck programme.
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