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September 2019 Volume 11  Issue 9 PHARMACYNEWSIRELAND.COM

THE INDEPENDENT VOICE OF PHARMACY

In this issue: NEWS: Irish pharmacy steps behind Page 5

PROFILE: Richard Woods on 65 years in Pharmacy Page 9

REPORT:

TH

ANNIVERSARY

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Pharmacy utilisation in eMental Health Page 18

NEWS: New Code of Conduct for Pharmacy Page 24

Without Prescription*

EDUCATION: Childhood Vaccinations Page 41

TEAM TRAINING:

For Continuous 24hr Protection

Heartburn Page 46

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The 2020

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For further information, please contact:

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Contents

Foreword

Page 4: LloydsPharmacy staff in Castletroy celebrate Lotto win

In startling, but not necessarily surprising statistics, it has been revealed that Ireland is lagging way behind the rest of Europe, and indeed the world, in the provision of community pharmacy services.

Page 6: Hardship scheme comes under fire

As the Irish Pharmacy Union made their calls to Government for extra funding to be made available in Budget 2020, they show the UK, Canada and New Zealand lead the charge in the provision of expanded patient services.

Page 9: Richard Woods reflects on 65 years in community pharmacy

The funding is needed, they say, to allow pharmacists to expand their service offering to patients in the community, and free up GP waiting lists.

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Page 12: New pharmacy opens its doors in Island Key

“If this happens, it could very well be the foundation stone for health service improvements,” comments Kathy Maher, IPU spokesperson and a community pharmacist at Haven Pharmacy in Duleek. Turn to page 5 for the full story.

Page 16: Pharmacy stores score in REI Top100

In other news, it has been announced that the HPV vaccine is now being given to all first year students in secondary school, including girls and, for the first time, boys. The uptake of the HPV vaccine has a participation rate of approximately 70%, which is an increase of 20% points since 2017.

Page 18: eMental health in Ireland and utilising the pharmacist Page 34: Uniphar volunteer at Hugh’s House

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It is clear many parents may be worried or have questions about the vaccine, opening the door for community pharmacies here to offer education and advice on the facts, especially given the amount of misinformation currently available.

PUBLISHER: IPN Communications Ireland Ltd. Clifton House, Fitzwilliam Street Lower, Dublin 2 00353 (01) 6690562

Childhood vaccination is an interesting topic for discussion for many reasons. It can be a polarising issue and it should not be taken for granted that all parents will responsibly put their child into the recommended immunisation schedule.

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

On page 41 of this issue, Pharmacist David Reilly MPSI looks at some of the key issues in the first of a 2-part educational special report.

EDITOR Kelly Jo Eastwood: 00353 (87)737 6308 kelly-jo@ipn.ie

In our October issue he will be looking at the HPV vaccine and the impact of social media on the roll-out of this.

ADVERTISING DIRECTOR Debbie Graham: 00353 (87) 288 2371 debbie@ipn.ie CONTRIBUTORS Kevin Cullen | David Reilly, MPSI DESIGN DIRECTOR Ian Stoddart Design

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IrishPharmacyNews

12 Irish Pharmacy News is IRISH 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.

We also feature the remaining winners from the 2019 Irish Pharmacy Awards, showcasing excellence and education that is continuing apace in community pharmacy here, despite many demands and restrictions on time and resources. I hope you enjoy the issue.

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FEATURE: WINTER REMEDIES

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News

LloydsPharmacy Castletroy scoops Lotto Win Pharmacy staff in Castletroy were celebrating last month, after scooping just over €65,000 in the Lotto. Joanne Shanahan, Rebecca Ryan, Lorraine Shinnors, Siobhan Treacy, Carmel Slattery, Edel Ryan, Aoife Molloy and Aideen McBrearty celebrate their win

Action on Obesity in Pharmacy With obesity levels showing no signs of decreasing, community pharmacists can play a pivotal role in supporting people to lose weight and to take on board a healthy lifestyle. Highlighting this ethos, new research carried out locally has shown that the children of Irish mothers who smoke are more likely to be overweight or obese. The results of this research provides further evidence as to the critical role played by community pharmacy teams in promoting healthier lifestyles and choices.

Each member of the 20-strong syndicate at LloydsPharmacy in Castletroy will receive ¤3,254.95 after they matched five of the winning numbers in the draw along with the bonus ball. The winning quickpick ticket was bought at Supervalu, Castletroy

hours before the midweek draw that had a ¤10m jackpot, which was not won. "We found out at about half nine when we went over (to Supervalu) and we had the Lotto ticket checked and it said to ring the National Lottery so I gave them a

buzz, called out the million-digit serial number of the ticket and he was really surprised that we didn't know and he was like 'oh you have won ¤65,000' and we were all a bit gobsmacked," explains Pharmacist Rebecca Ryan. "We are all delighted. It's really exciting, it's not go crazy money but you can get rid of some things like house improvements and stuff that you need to get done so it’s fantastic," she said.

Pharmacy to advise on HPV Vaccine Pharmacists are being urged to step-up and utilize their role in advising customers about the HPV vaccine, as the HSE announced the 2019/20 school HPV vaccine programme. The HPV vaccine is now being given to all first year students in secondary school, including girls and, for the first time, boys. The uptake of the HPV vaccine has a participation rate of approximately 70%, which is an increase of 20% points since 2017. It is clear many parents may be worried or have questions about the vaccine, opening the door for community pharmacies here to offer education and advice on the facts, especially given the amount of misinformation currently available. IPU Committee Member and community pharmacist Gráinne O’Leary says, “There is a lot of misinformation about the HPV vaccine, particularly on social media. This misinformation stokes unnecessary fears in young

people and their parents, which can lead to a lower uptake.” Ms O’Leary emphasized that local pharmacists should be a key point of contact for those with any concerns on this, or any other vaccination. The HPV vaccine saves lives and it is safe and effective. It helps prevent infection caused by the human papillomavirus (HPV), one of the leading causes of cervical cancer and other cancers. In Ireland, almost 300 women develop cervical cancer every year and almost 90 die because of it. HPV also causes oropharyngeal, vaginal, penile and anal cancers. More than 100 million people worldwide have received the HPV vaccine, and in Ireland more than 240,000 girls have been fully vaccinated. Ms O’Leary continued, “It is

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understandable that when people read negative comments about the HPV vaccine that they will have questions. What we are asking people to do, is to bring those questions to their pharmacist, who is a highly trained medical professional and will be able to present you with the facts. Community pharmacists are the most accessible part of the healthcare system – there are over 1,900 pharmacies around the country, with half the population living within one kilometre of a pharmacy. We have long opening hours, including weekends, and we are here to help. “There is a lot of fiction out there on this issue, and the noise around it can be overwhelming. Let us help you to cut through the noise, so you have the facts and can make an informed decision. Get the facts, talk to your pharmacist.”

The University College Cork research on primary carers, 98% of whom were biological mothers, discovered a link between maternal smoking postnatally and obesity in children aged three and five. It found that children exposed to maternal smoking or primary carers’ smoking are 30% more likely to be overweight or obese at age three, and 31% more likely to be obese or overweight at age five, compared with children of nonsmoking mothers. The study’s lead author, Salome Sunday, said there is a theory that secondhand smoke is linked to a child’s weight. “It has been hypothesised that inhaling the chemicals in tobacco smoke (secondhand smoke exposure) may cause impaired metabolic and immune functions, leading to an increase in the child’s susceptibility to obesity,” she said. It is understood the research, which used findings gathered from more than 11,100 children in the Growing Up in Ireland study, is one of the first Irish studies to examine how secondhand smoke from primary carers is linked to childhood obesity. “Both childhood obesity and secondhand childhood exposure are public health issues in Ireland,” said the authors. Childhood obesity is linked to a string of health conditions later in life, including an increased risk of type 2 diabetes, heart diseases, cancer, as well as lifelong overweight and obesity.


News FMD Use and Learn Extension As outlined below, the FMD safety feature requirements came into effect on 9th February 2019. During this time, the system in Ireland has been in ‘use and learn’ phase to ensure the continuity of safe supply of medicines to patients while all parties gained a better understanding of the new system. The National Safety Features Oversight Group comprising the IMVO, the Department of Health, the Health Products Regulatory Authority (HPRA), the Pharmaceutical Society of Ireland (PSI), the Health Service Executive (HSE) and the Private Hospitals Association (PHA) has been closely monitoring progress since go live on 9th February. Taking all factors into account, the group has decided that the use and learn period will be further extended to allow additional time for the system to stabilise and to ensure that everyone is ready when it becomes mandatory to investigate and close out all alerts before supplying the packs. The use and learn period will end on a phased basis, and a detailed plan as to how this will be done, including dates, will be published at the end of September. Significant progress has been made on several fronts since 9th February: - The vast majority of pharmacies, hospitals and wholesalers have registered with the Irish Medicines Verification Organisation (IMVO) and are connected to the national system. - Almost 11.3 million scans of packs of medicines have taken place in Irish pharmacies, hospitals and wholesalers since February and the number of scans is growing weekly. - Barcode data for over 180 million packs has been uploaded to the national system by manufacturers. In the meantime, pharmacies, hospitals, wholesalers and manufacturers/MAHs are asked to continue following the instructions given to them when the use and learn period was last extended in May.

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Ireland behind the pace in Pharmacy services Ireland is currently lagging far behind international best pharmacy practice. Health Monitoring and Awareness New Medicine Services Minor Ailment Scheme Chronic Disease Management INR Testing

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Australia

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That is one of the key messages to come out of the Irish Pharmacy Union’s calls to Government for extra funding to be made available in Budget 2020, to allow pharmacists to expand their service offering to patients in the community, and free up GP waiting lists. Currently, the UK, Canada and New Zealand (see chart) lead the charge in the provision of expanded patient services. Budget 2020, says the IPU, provides an opportunity to change this. “If this happens, it could very well be the foundation stone for health service improvements,” comments Kathy Maher, IPU spokesperson and a community pharmacist at Haven Pharmacy in Duleek. The IPU is calling for the expansion of pharmacy services, including the introduction of: • A Minor Ailment Scheme; • A New Medicine Service, which will help drive prescription adherence; • A Chronic Disease Management Service; and

Netherlands New Zealand

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• Improving Access to Contraception for women. Research has indicated that 18% of a GP’s workload is spent on minor ailments and that the timely delivery of the Minor Ailment Scheme could save up to 950,000 GP consultations every year. A successful pilot of a Minor Ailment scheme was conducted in 2016, but the HSE has yet to make any decisions on a wider implementation. Ms Maher adds, “Community pharmacy is the most accessed part of Ireland’s health system, with nearly 78 million visits to a pharmacy every year. The spirit of the Sláintecare plan is for care to be provided at the lowest level of complexity. Pharmacies open long hours and over weekends and can be attended without appointment – that is why, for a range of services, community pharmacies are the logical providers of care. Pharmacists can bring added value to both the patient and the HSE. As demand for healthcare continues to increase, the State cannot rely on traditional models of

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care and it must be recognised that pharmacists are part of the solution.” The Programme for Government gave a clear commitment to expand pharmacy services within two years. Ms Maher said that while that hasn’t happened, “we are still optimistic that the Government will see the opportunities that exist and implement changes. However, our members now need to see flesh on the bones of these commitments, and Budget 2020 provides an opportunity to ring-fence funding to deliver on Government objectives.” She added: “Our members are ideally positioned in every town and city in Ireland to deliver key patient services that are currently within the remit of GPs who are frankly over-stretched. We can reduce this pressure on the system and make decisive interventions that will deliver a high standard of care for patients in their communities while driving efficiencies and ensuring better value for taxpayers’ money and cutting the waiting lists in GP clinics.”

Pharmacy Fraud under investigation It is understood, that the HSE is investigating multiple cases of fraud committed by community pharmacies, some dating back over 6 years. Irish Pharmacy News believes at least ten Clause 16 investigations against several pharmacies in Ireland are being carried out. A Clause 16 inquiry is the name given to serious internal investigations carried out by senior members of the health service. Investigations are now ongoing into pharmacies based in north Dublin, Wicklow, Louth and Limerick. The majority of these investigations centre around phased dispensing. One case allegedly involves a pharmacy filling prescriptions to residents of a number of local nursing homes in the area.

However, in recent weeks, the HSE has become aware of an anomaly whereby there were more scripts filled than people at the nursing homes It is understood that the total money being queried by the HSE runs into the hundreds of thousands of euro. A number of pharmacies have been sued by the HSE in recent months in relation to similar incidents. Speaking in relation to phased dispensing, a spokesperson for the Irish Pharmacy Union said, “This is a vitally important facility for certain patients who cannot safely and

effectively manage their medication regimen. Phased dispensing allows a patient’s pharmacist, family members and carers to support and ensure the safe and proper use of the medicine by the patient. “If an allegation has been made, the pharmacist concerned is entitled to a proper investigation before any conclusion is reached.” Irish Pharmacy News would like to hear your views and opinions on this subject, as we will be writing a special report on this issue in our October edition. Get in touch with the Editor at: kelly-jo@ipn.ie

PHARMACYNEWSIRELAND.COM


6

News

Hardship Scheme comes under fire

New Research on Cerebral Palsy

The community pharmacy hardship scheme has come under fire. A poll carried out recently by PharmaBuddy found that a very small minority of community pharmacists were happy with the current state of the hardship scheme.

Adults with cerebral palsy are about twice as likely to develop cardiovascular disease and chronic respiratory disease compared to adults without cerebral palsy, according to a new study led by Royal College of Surgeons in Ireland (RCSI) and Brunel University London.

When posed with the question, ‘There must be a better alternative to the hardship scheme’ an overwhelming majority agreed, some 98.34%. Only 1% disagreed.

Pharmacy teams can help those with cerebral palsy to support medicines optimisation, for example. Research also shows that being able to access health professionals, such as pharmacists, with knowledge of cerebral palsy early, may slow deterioration in the patient’s function and prevent development of secondary conditions with age.

Less than 1% were unsure. The HSE launched the medical hardship scheme in 2016. It covers medical card holders for items prescribed by the Doctor that are not usually reimbursable by the HSE. There are specific conditions that must be satisfied before the HSE will approve the application.

Fitzgibbons totalhealth Pharmacy Fitzgibbon's totalhealth Pharmacy in Mitchelstown, Co. Cork celebrated their Grand Opening last month. Huge congratulations to Karagh Fitzgibbon and her fabulous team in Mitchelstown. A great day was had by all.

The study compared 1,700 adults with cerebral palsy and 5,000 adults without cerebral palsy to identify how many developed non-infectious diseases, such as asthma or stroke. Patients with cerebral palsy were overall 75% more likely to have a non-communicable disease. After adjusting for other variables, the study found that adults with cerebral palsy were around twice as likely to develop cardiovascular disease and chronic respiratory disease, such as asthma, but not more likely to develop diabetes or cancer. Adults with cerebral palsy were specifically 2.6 times more likely to develop heart failure, 5.5 times more likely to have a stroke, 2.2 times more likely to develop asthma, 1.6 times more likely to develop hypertension and 2.3 times more likely to develop ischaemic heart disease.

Pictured is Pharmacist Karagh Fitzgibbon with her pharmacy staff

Community Pharmacy Roundtable Interested in attending a meeting of peers to discuss education programmes for Oral Chemotherapy Education in a Community Pharmacy setting? Anne Marie DeFrein, Chief II Pharmacist with the National Cancer Control Programme will be holding informal, conversation focused groups this month (September) and is looking for participants who would like to add their views. This roundtable will be approximately one hour in duration and will be held in central Dublin (NCCP offices on Parnell Street) in the evening from 6.30 -8pm. Food and drink will be provided and this offers a great opportunity to meet other pharmacists in an informal setting. Get in touch directly for available slots via amdefrien@tcd.ie

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Globally, approximately 17 million people have cerebral palsy. Although cerebral palsy was historically considered a paediatric condition, the majority of children with cerebral palsy now survive into adulthood and many adults with cerebral palsy have a near normal life expectancy. Cerebral palsy is not a progressive condition. However, at least a quarter of young adults report that their ability to walk gets worse, which may contribute to the development of chronic health conditions.


TRELEGY ELLIPTA

(fluticasone furoate/umeclidinium/vilanterol) The only COPD Triple Therapy delivered in a single daily inhalation.1 Improvement in lung function and quality of life vs. ICS/LABA.2,3

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A combination of ICS/LAMA/LABA (FF/UMEC/VI) administered through a single daily inhalation from the Ellipta inhaler, which is easy to use1-5 ▼This medicinal product is subject to additional monitoring. This will

allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions. TRELEGY Ellipta FF/UMEC/VI 92/55/22 mcg OD is indicated for Maintenance treatment in adult patients with moderate to severe COPD who are not adequately treated by a combination of an inhaled corticosteroid (ICS) and a long-acting β2-agonist (LABA) or a combination of a LABA and a long acting muscarinic antagonist. COPD, chronic obstructive pulmonary disease; FF, fluticasone furoate; ICS, inhaled corticosteroids; LABA, long-acting β2-agonist; LAMA, longacting muscarinic antagonist; OD, once-daily; UMEC, umeclidinium, VI, vilanterol. References: 1. TRELEGY Ellipta SmPC, available at www.medicines. ie, last accessed January 2019. 2. Lipson DA et al. Am J Respir Crit Care Med 2017; 196:438–446. 3. Lipson DA, et al. N Engl J Med. May 3 2018;378(18):1671-1680. 4. Svedsater H et al. BMC Pulm Med 2013; 13:72–86. 5. van der Palen J et al. NPJ Prim Care Respir Med 2016; 26:16079. Trelegy▼Ellipta (fluticasone furoate/umeclidinium/vilanterol [as trifenatate]) Prescribing information. Please consult the full Summary of Product Characteristics (SmPC) before prescribing. Trelegy Ellipta (fluticasone furoate/umeclidinium/vilanterol [as trifenatate]) inhalation powder. Each single inhalation of fluticasone furoate (FF) 100 micrograms (mcg), umeclidinium bromide

(UMEC) 62.5 micrograms and vilanterol as trifenatate (VI) 25 mcg provides a delivered dose of 92 mcg FF, 55 mcg UMEC and 22 mcg VI. Indications: Maintenance treatment in adult patients with moderate to severe COPD who are not adequately treated by a combination of an inhaled corticosteroid (ICS) and a long-acting β2-agonist (LABA) or a combination of a LABA and a long acting muscarinic antagonist. Dosage and administration: One inhalation once daily at the same time each day. Contraindications: Hypersensitivity to the active substances or to any of the excipients (lactose monohydrate & magnesium stearate). Precautions: Paradoxical bronchospasm, unstable or life-threatening cardiovascular disease or heart rhythm abnormalities, convulsive disorders or thyrotoxicosis, pulmonary tuberculosis or patients with chronic or untreated infections, narrowangle glaucoma, urinary retention, hypokalaemia, patients predisposed to low levels of serum potassium, diabetes mellitus. In patients with moderate to severe hepatic impairment patients should be monitored for systemic corticosteroid-related adverse reactions. Eye symptoms such as blurred vision may be due to underlying serious conditions such as cataract, glaucoma or central serous chorioretinopathy (CSCR); consider referral to ophthalmologist. Increased incidence of pneumonia has been observed in patients with COPD receiving inhaled corticosteroids. Risk factors for pneumonia include: current smokers, old age, patients with a history of prior pneumonia, patients with a low body mass index and severe COPD. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take Trelegy. Acute symptoms: Not for acute symptoms, use short-acting

inhaled bronchodilator. Warn patients to seek medical advice if shortacting inhaled bronchodilator use increases. Therapy should not be abruptly stopped without physician supervision due to risk of symptom recurrence. Systemic effects: Systemic effects of ICSs may occur, particularly at high doses for long periods, but much less likely than with oral corticosteroids. Interactions with other medicinal products: Caution should be exercised with concurrent use of β-blockers. Caution is advised when co-administering with strong CYP3A4 inhibitors (e.g. ketoconazole, ritonavir, cobicistat-containing products), hypokalaemic treatments or non-potassium-sparing diuretics. Co-administration with other long-acting muscarinic antagonists or long acting β2-adrenergic agonists is not recommended. Pregnancy and breast-feeding: Experience limited. Balance risks against benefits. Side effects: Common (≥1/100 to <1/10): pneumonia, upper respiratory tract infection, bronchitis, pharyngitis, rhinitis, sinusitis, influenza, nasopharyngitis, candidiasis of mouth and throat, urinary tract infection, headache, cough, oropharyngeal pain, arthralgia, back pain. Uncommon (≥1/1,000 to <1/100): viral respiratory tract infection, supraventricular tachyarrhythmia, tachycardia, atrial fibrillation, dysphonia, dry mouth, fractures; Not known (cannot be estimated from the available data): vision blurred. Marketing Authorisation (MA) Holder: GlaxoSmithKline Trading Services Limited, Curabinny, Co. Cork, Ireland. MA No. [EU/1/17/1236/002]. Legal category: POM B. Last date of revision: January 2019. Job Ref: IE/TLY/0006/17(4). Further information available on request from GlaxoSmithKline, 12 Riverwalk, Citywest Business Campus, Dublin 24. Tel: 01-4955000.

Adverse events should be reported to the Health Products Regulatory Authority (HPRA) using an Adverse Reaction Report Form obtained either from the HPRA or electronically via the website at www.hpra.ie. Adverse reactions can also be reported to the HPRA by calling: (01) 6764971. Adverse events should also be reported to GlaxoSmithKline on 1800 244 255. A full list of adverse reactions can be found in the Summary of Product Characteristics. In common with other corticosteroid-containing medicines, there is an increased risk of pneumonia in patients with COPD treated with TRELEGY Ellipta.1 Trelegy Ellipta should be used with caution in patients with unstable or life-threatening cardiovascular disease.1

Please see www.trelegy.ie to find out more

TRELEGY Ellipta was developed in collaboration with TRELEGY and Ellipta are registered trademarks of the GlaxoSmithKline Group of Companies. © 2019 GlaxoSmithKline Group of Companies. All rights reserved. Zinc code: I E /TLY/0004/17(2)a(2) Date of preparation: March 2019


“56 years – that’s a long time in Pharmacy” Mullingar Pharmacist Richard Woods hangs up his pharmacy coat and passes on the mantle. Richard Woods set up his first pharmacy in Mullingar, Co Westmeath in a leased premises some 44 years ago and began what would become a very successful career lasting to beyond retirement age. Richard is a staunch businessman, who has seen pharmacy change dramatically over the course of his long career and the changes that he has witnessed have been both positive and negative. Just this year he decided the time was right for him to retire and the pharmacy is now in the very capable hands of Robert and John Keane who already own pharmacies in Mullingar and Enfield. Robert Keane’s parents and grandparents had been customers of Woods Pharmacy and this is something of value to Richard. “The shop will very much continue to operate at Woods Pharmacy, with all the staff except myself staying on,” he says. “Robert Keane, who has managed the pharmacy in Green Road since 2010, will be taking over as the pharmacist and I am happy that the Keane brothers will take great care of my customers and the community.” In the Beginning When Richard Woods began his career in pharmacy in 1963, it was more of a personal and local affair than it is now. “The 'chemist' was generally a local man/woman and, back then we used to know the local people and their families quite well. I still know many of my customers. In fact, we have third and fourth generations of families here, who still come in to us, which is great. But back then, when people

Richard Woods, Pharmacist, Woods Pharmacy Mullingar

brought in their prescriptions, they were usually quite straight forward to dispense. There wasn’t a huge amount of paperwork or computerised systems and it all ran very smoothly. Life was much simpler.” Having initially begun his career in hospital pharmacy, where he met his wife, who was working as a nurse in Warrington Hospital in the UK, Richard originally came from Liverpool but, having three Irish grandparents he now counts himself as an Irishman and has spent the majority of his working life in Ireland. He currently resides in Mullingar near his five children and grandchildren. With no view of retirement, ten years ago he chose to invest and expand his business rather than winding it down. And, this he did in an inspiring way. He said, “My wife died in 2005, and by 2008 I was becoming

thoroughly fed up of everything. I thought “that’s it, I think I might retire next year”. I came out of the pharmacy one day and I walked down the road to the local newsagents. I had to walk past about five or six shops to reach the local newsagents and I noticed that there was an empty premises about three doors down from my pharmacy. It was a really big premises and I thought to myself that it would make a lovely pharmacy. So I went home that night and I said it to my children and they said to me, ‘Dad this time last week you were thinking of retiring.’ At the time I was 68 but I told them ‘Yes I know, but I would love to give the pharmacy one last push before I retire.” In 1974, when he and his wife first moved to Mullingar, they decided to take out a pension plan, which was unusual at the time because not very many people thought about pensions in those days.

“We started to put £20 a month into the pension plan and, as things began to improve we started putting more in over the years,” he said. “By 2001 we were putting the maximum amount that tax would allow into the plan so I thought I would enquire about what was in the pension fund.” So, when his current premises came onto the market, Richard found that, by using his pension fund plus the money that he had saved in the bank, he was in a position to make a bid for the empty premises. He negotiated for four months and eventually, once the price had been agreed he was able to purchase the premises outright. He said, “I officially opened the new pharmacy in December 2009. It is about ten times larger than my old pharmacy and I had it fitted out professionally. Unfortunately, just as I set up the new pharmacy, all the HSE

PHARMACYNEWSIRELAND.COM | 9


Richard Woods as a young pharmacy graduate

“Both our parents and our grandparents were customers of Mr Woods for many years. We know that they tremendously valued his characteristic courtesy and helpfulness and we will do our very best to carry these values into the future” Robert Keane, new owner of Woods Pharmacy, Mullingar

cuts, fees, reference prices, etc started to come in and the cuts obviously affected our turnover and profitability.” Richard, like many pharmacists, has become increasingly frustrated with how Pharmacy is run these days and says that, in his opinion, there are far too many HSE schemes. He also said that he does not understand why the HSE cannot implement an easier and simpler way of doing things. “At the moment we have the GMS prescription, the GMS 3-month repeat prescription, the Drugs Payment Scheme, the Long Term Illness Scheme, the Hi Tech Scheme, the Hardship Scheme, the Methadone Scheme and then, in Dublin pharmacists have the Psychiatric Drugs' Scheme and also the Children’s Scheme. Why do we need so many schemes? Why can’t we have just two schemes – the Private Patient’s Scheme and a Medical Card Scheme? I often think that all of these schemes only exist to make work for civil servants rather than making it easy for a patient to obtain their medication.”

he has always enjoyed his independent status. “I like to be able to look out and see the people who come into my pharmacy and look after them as best I can," he said. "I like to have a joke with them as well. Although health is a serious business, there can also be a light-hearted side to it as well. “At the moment, from what I can see, pharmacy is being buoyed up by new pharmacy openings. I think some of them are possibly being supported by some of the wholesalers but, to me, that is a false kind of success, is it not? If a business cannot stand on its own two feet, then why prop it up? That’s just my theory but I feel that if the wholesalers didn’t do that and people had to open up their own businesses under their own steam, there wouldn’t be as many pharmacies in Ireland.” He reflects that the first time that the HSE spoke about introducing price cuts into Irish Pharmacy, he felt that all the pharmacists should go on strike immediately in order to make an impact which, he felt would resolve the issue swiftly.

Changing Times Over the past four decades, Richard has seen an increase in group chains and franchise pharmacies springing up in the Republic of Ireland but says

Richard is pictured with his grandson Stephen Richard Woods

10 | PHARMACYNEWSIRELAND.COM

However, the general consensus was that pharmacy would have to give the HSE three months' notice before doing this because some people felt that patients with cancer or in need of life saving

medication would suffer. His response was simple. “Were they so stupid to think that I wouldn’t look after those people? I’d look after them out the back


door rather than the front door and I would have still been able to wave my strike banner at the front of the pharmacy. I am long enough in the business now, and subsequently my wife had cancer, that I would never refuse anybody who needed medication. But, of course people disagreed. So we waited to go on strike and the rest is history. Now, every time the Government wants to make cuts it does so because they know we’re not going to go on strike.” According to Richard, another factor looming in the ongoing list of issues that independent pharmacists currently face is the group factor. He explained, “The other problem with pharmacists going on strike is the fact that the larger chains won’t join the picket lines. I had a woman in my pharmacy prior to our strike and she asked me ‘What are we to do when you go on strike?’ I told her to ring the HSE and put it to them as they were the reason that we were going on strike. She came back in to me a week later and said that she had rung the HSE and they had told her that if I wouldn’t supply her medication, one of the larger chains would. That says it all really. I mean the HSE was

recommending a group, which has openly admitted that they want to dominate Irish Pharmacy.” He continued, “If that does happen and one group manages to acquire the majority of control over Irish Pharmacy, what would happen when and if the HSE wanted to implement further initiatives in the future? If a group held a majority stake holding, they could threaten to close all their pharmacies if they didn't agree and, consequently that could potentially hold influence over the HSE, rather than the other way around.” Looking to the future he says that it is a worrying time for independent pharmacy but if the HSE would work with the profession, there are ways that it could work. Mr Woods fondly recalled, “Every morning when I went into my pharmacy, which is a long thin shop, I entered through the back door and went into the dispensary. When I flicked on the lights, they came on one by one in sequence the whole way down the pharmacy. Every time that happened I thought ‘Yes, let’s get this show on the road.’ This was a great feeling to have. I've enjoyed my career and feel very grateful

to all the customers and staff for their support over the years and humbled by their warm wishes on my retirement.”

Richard Woods with new owners John and Robert Keane and his pharmacy team

Looking Ahead The pharmacy has been taken over by Robert and John Keane, of Keane’s CarePlus Pharmacies. John Keane says, “All of the Keane’s family are honoured to begin managing one of the most respected businesses in Mullingar. We want to take this opportunity to wish Mr Woods a very happy retirement. “As local pharmacists, we have always admired the work, care and support he has provided to the community of Mullingar for many years. Very few people have provided as much service to the people of Mullingar as Mr Woods and we look forward to continuing to offer as much support and advice to local people as possible with the help of his wonderful team in Dominick Street. “Both our parents and our grandparents were customers of Mr Woods for many years. We know that they tremendously valued his characteristic courtesy and helpfulness and we will do our very best to carry these values into the future.

“Over the coming weeks, Robert Keane will be moving from our Green Road Pharmacy that he has managed for almost 10 years to work with the team at Woods Pharmacy. We look forward to getting to know both the staff and the customers over the coming weeks, months and years and are completely honoured that Mr Woods has chosen to hand the baton over to another local family. We wish Richard every happiness in his retirement after a lifetime of service to the people of Mullingar.” Richard is looking forward to many things in his retirement, not least of which is watching his favourite football team, Liverpool in real time, without any customers coming in to tell him the results. He concludes, “Over the past 56 years I have worked with many people but can honestly say that the present team are the best! Thanks girls for everything....the laughter and the tears!”

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O’Casey’s Pharmacy opens its doors Months of planning, hard work and leaflet/social media drops paid off for two local ladies on Friday 26th July when the doors of O’Casey’s Pharmacy officially opened in Island Key, East Road. Fionnuala Johnstone MPSI, Lord Mayor East Wall, Shane Gallagher, KDL Retai), Janine O’Hara, Front-Of-Shop Supervisor

Appointments sought on PSI Accreditation Panel As part of its role to set standards for pharmacist education and training, the Pharmaceutical Society of Ireland requires people to sit on accreditation teams to evaluate and review national pharmacy degree programmes through an accreditation process. They are now seeking expressions of interest from suitably qualified individuals to participate on future accreditation teams. This process is intended to establish a panel, from which it can invite individuals to participate as accreditation team members for future accreditation visits.

With a combined pharmacy service of 11 years in the locality, Fionnuala Johnstone (MPSI) and Front of Shop Supervisor Janine O’Hara had an amazing day planned for their customers. FM104 provided the entertainment with the “Road Hog” parked on the street outside, the occasion was marked with a series of events throughout the day, with specialists from Bioderma Skincare, Spotlight teeth whitening on hand to offer their advice, refreshments, goody bags and spot-prizes as well as the official ribbon cutting ceremony by East Wall’s Lord Mayor all took place.

Janine O’Hara, Front-Of-Shop Supervisor with Fionnuala Johnstone, MPSI

It is fair to say that the pharmacy is attracting lots of attention from the local community, with its excellent layout and merchandising, lighting and accessibility. With one customer quoting on the day that, the atmosphere gave

them “an instant lift and feeling of well-being.” Pharmacy services include: Prescription services and advice, state of the art Consultation Room, including Video Doc service, a convenient prescription ordering app, skincare & healthy living advice to name a few. Fionnuala and Janine have an interest and expertise in Female Health & Wellbeing, Skincare & Healthy living, services they will continually strive to develop for the wellbeing of their community in the future. Fionnuala told Irish Pharmacy News she would like to see, “Pharmacies providing more services to the community in the coming years” …. So, watch this space as O’Casey’s Pharmacy continues to grow their pharmacy services in the Dublin 3 community.

All-Ireland Pharmacy Conference The 9th All Ireland Pharmacy Conference will be held at Ballymascanlon House Hotel, Dundalk on 14th and 15th October 2019. 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.

through pharmaceutical workforce transformation.

The conference is themed around the FIP Pharmaceutical Workforce Development Goals.

On the evening of Monday 14th October 2019 the conference dinner will take place at 8.00pm and provides an opportunity to network with colleagues. The main conference proceedings will start at 9.30am on Tuesday 15th October 2019. The remainder of the conference will involve parallel oral sessions and poster presentations.

Dr Catherine Duggan (CEO, International Pharmaceutical Federation FIP) will give the keynote address, entitled Delivering the WHO Primary Health Care agenda: strategies to meet national care needs

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Under the PSI’s (Education and Training) (Integrated Course) Rules 2014, the PSI Council appoints accreditation teams to evaluate a pharmacy programme (MPharm). The role of the accreditation teams is to evaluate an application for accreditation and continued accreditation against the PSI Accreditation Standards, and make a recommendation to the PSI on whether or not it should accredit the programme. Accreditation team members must have an appropriate range of expertise in order that the teams can collectively perform its function to the standards required. Accreditation team members must demonstrate certain competencies, including: • Knowledge, expertise or experience in particular areas • Decision making skills • Communication and interpersonal skills • Teamwork • Public values If you are interested in becoming a panel member for appointment to an accreditation team, please read the information booklet containing details about the role, accreditation process, required experience, time commitment and remuneration. If you wish to apply to be part of an accreditation team, please complete this application form and return by e-mail to: andrea.boland@psi.ie or by post to: Andrea Boland, Education Standards Officer, PSI House, 15-19 Fenian Street, Dublin 2, D02 TD72


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Shock at Medical Card Cancellations More than 200,000 medical card applications have been cancelled by the HSE over the past three years because information was not submitted in time. The Medical Card Scheme provides free primary care, including free GP care, hospital services and medicines. The costs are taken on by the State and the scheme is means tested. However, there is a Prescription Levy of ¤2.00 per item on medicines, with a cap of ¤20.00 per month. Seán Fleming, the Fianna Fáil TD and chairman of the public accounts committee, described it as a “shockingly high figure” and called on Simon Harris, the Health Minister, to explain it. The HSE said that 18,894 were cancelled in the first half of this

year, 64,817 last year, 68,767 in 2017 and 58,122 in 2016. The information was released after a parliamentary question by Mr Fleming. “Anyone who has filled out a medical card application form knows that a lot of work and attention goes into filling out the form and into supplying the documentary evidence,” he said. The HSE made the determinations on 210,600 cases, based on the fact that their applicants had not supplied the requisite information within a reasonable time period. The HSE said the 210,600 applications were cancelled

because a "decision outcome could not be based on a comprehensive assessment of eligibility, arising from the failure to furnish appropriate documentations/material within a reasonable timeframe". These applications related to Medical Card/GP Visit Card applications, both from new applicants and from those with cards seeking to have a soonto-be-expired card reviewed and then hopefully renewed. Deputy Fleming alleged that he has come across several cases where submitted documents were never received by the HSE.

Amy moves up Hickeys Pharmacy Ladder Amy Flynn joined Hickey's Pharmacy as a Relief Pharmacist in 2012 and since that time has progressed to being Supervising Pharmacist in one of our busiest pharmacies at Northside Shopping Centre (which is also where Hickey's Pharmacy first began nearly 25 years ago). Amy Flynn, Supervising Pharmacist and Pharmacist Recruiter, Hickey’s Pharmacy

Amy will now also be managing the recruitment of pharmacists and the training of Hickey’s Pharmacy interns as part of the support office team. We wish Amy every success in her new role!

Launch of OroSoothe Phoenix Labs as announced the launch of OroSoothe 0.15% w/v Oromucosal Spray. OroSoothe will be available in all pharmacies from the 16th September OroSoothe is an OTC medication and is indicated as an adjunct in the symptomatic relief of painful inflammatory conditions of the throat and mouth. Qualitive and quantitative composition: 1ml of the solution contains 1.5mg of benzydamine hydrochloride.

Phoenix Labs is a leading integrated healthcare company operating in both prescription and OTC markets in the Irish pharmaceutical market. Phoenix Labs also markets an extensive range of products around the world in countries including Australia, New Zealand, Austria, Germany, Spain, Italy, France, Czech Republic, Slovakia, Hungary, Sweden, Finland,

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Denmark, Netherlands, Portugal, Greece, Cyprus and the UK. Phoenix Labs are proud of their expanding businesses which now include market-leading brands such as Uniflu, Exputex and a range of other prescription and OTC products. For more information please contact: +353-1-4688900 info@phoenixlabs.ie

High Pollen Count warning to Pharmacy Pharmacists and their teams need to be aware of expected high pollen levels currently in existence. The Asthma Society of Ireland is warning the 304,000 people who have both asthma and hayfever in Ireland to take precautions. The Asthma Society has teamed up with Dyson Ireland to launch its Pollen Tracker on asthma.ie. The tracker provides an update of pollen levels across the four provinces each day, and a predictor of the pollen levels for the following day. Sarah O’Connor, CEO of the Asthma Society of Ireland, says, “For the 304,000 people who have asthma and hayfever, hayfever can be particularly dangerous. “Hayfever symptoms are capable of escalating an asthma attack, which in some cases can be fatal. Asthma deaths are rising in Ireland, with one person now dying every six days as a result of their asthma. In addition, people with hayfever experience symptoms which really compromise their quality of life and ability to enjoy the summer months.” Dr Marcus Butler, Medical Director of the Asthma Society added, “Managing asthma becomes more difficult over the summer months as the nice weather brings a long and sharp increase in the pollen count. “Research suggests that up to 80% of people with asthma notice a worsening of asthma symptoms due to allergies such as pollen, as their bodies trigger an allergic reaction. “I see a drop in asthma control amongst my allergic asthma patients during hayfever season, which leaves them at risk of a more serious asthma attack. It is vital that all asthma patients with pollen or grass allergy have an Asthma Action Plan and prepare for the hayfever season to limit its effects.”


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Success for 13 Pharmacies in REI Top100 Thirteen community pharmacies have this year made it on to the list of Retail Excellence’s Top100 Stores in Ireland. Sam McCauley, McCauley Health & Beauty with David Fitzsimons, Group Chief Executive, Retail Excellence Ireland at the opening of the Charlemont Store earlier this year

The Retail Excellence Awards, will take place on Saturday, November 9th in the Great Southern Hotel in Killarney.

The Top100 stores are part of the Retail Excellence Awards, which were established in 1997 to promote best practice and encourage high standards in the Irish retail industry and are now the largest and most prestigious of its kind in Ireland. Scoring twice were the Adrian Dunne Pharmacy Group for their pharmacies in Balbriggan and Kilbarrack; Cunningham’s Pharmacy for their Auburn Retail Centre in Athlone and Monskland, Athlone stores; McCabes Pharmacy for their Blanchardstown and Malahide stores; and McCauley Health & Beauty Pharmacy with their flagship Charlemont Street Pharmacy and New Ross Pharmacy. Also making the shortlist was Allis Pharmacy in Knocklyon, Dublin,

Liberty Pharmacy in Thurles, Lynch’s Pharmacy in Kells, Phelan’s Pharmacy in Skehard Road, Cork, and Walkers Chemist in Enfield, Meath. Lisa Byrne, Superintendent Pharmacist with Adrian Dunne Pharmacy Group commented, “We are so delighted that two of our pharmacies are listed as Ireland's Top100 stores. Fantastic achievement to be finalists in the Retail Excellence Awards. Well done to all the team at Adrian Dunne.” McCauley Health & Beauty Pharmacy opened its Charlemont Street concept pharmacy at the start of this year. The greenfield city centre location provides a unique offering, and falls in line with the company’s plans for further development.

David Fitzsimons, Group Chief Executive of Retail Excellence commented, “There were almost 700 entries nationwide and as with other years we are delighted with the quality of applicants this year. The very high standard of service, customer engagement and display among Irish retailers was very evident which made selecting this year’s Top100 particularly difficult. I want to commend all who entered this year and in particular, I want congratulate the Top100 stores for making it through. Those named as Top100 finalists have what it takes to shine through and be recognised as the best retailers in the country”. As part of the Top100 selection process, all store entrants were visited by a mystery shopper, with those exceeding service and standards criteria making it to the Top100 stores. The Top100 will now be invited to a private briefing with Echochamber, a creative retail agency who tracks global retail trends, where they will be presented with the 10 pillars of Retail Excellence and will be given time to prepare a submission showing evidence they meet those 10 pillars.

Dates for your Diary The Pharmaceutical Managers’ Institute (PMI) has a number of upcoming events for your diaries. 26th September – NCPE Briefing Breakfast with Dr Lesley Tilson, NCPE Dr Lesley Tilson is Chief Pharmacist & Deputy Head with the National Centre for Pharmacoeconomics. She will be joining the PMI for the now annual NCPE Briefing on reimbursement, policy updates and challenges facing the industry in the Clayton Hotel, Liffey Valley.

such as remote care monitoring. In the HSE, the focus is changing from managing “sick people” to “keeping well people, well” – with a strong desire to shift away from an “analog” healthcare system to a digital healthcare system through Open Innovation.

10th October – Masterclass

Taking place in the IMI Sandyford, this one day masterclass will explore the growing links between technology and healthcare, point to where the areas of growth are, and what this continued landscape change will mean – both to pharma companies, and to the patients.

By 2025, Gartner expects that a third of care interaction will be through virtual health technology

This masterclass is proudly sponsored by Point of Care

This breakfast is proudly sponsored by Ashfield

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New calls to halt vitamin VAT Revelations by a Donegal GP that a severe lack of sunshine in the North West is to blame for low levels of Vitamin D and a high volume of people suffering with osteoporosis has led to reiterated calls for the Government to halt plans to impose VAT on food supplements. The Irish Pharmacy Union, alongside Health Stores Ireland, the trade association for Ireland's health stores, have been campaigning against the price increases. A study carried out by Dr Martin Coyne showed that out of 10 thousand tests carried out at Letterkenny University Hospital, 75% of samples had insufficient vitamin D levels. Plans to impose VAT on food supplements from March 1st this year were delayed to allow for a public consultation. Spokesperson for Health Stores Ireland, Matt Ronan says the results of Dr Coyne’s is evidence of how vital food supplements are for some. The low levels of the vitamin is one of the leading causes of osteoporosis – a condition which affects 300,000 people in Ireland. Symptoms of osteoporosis include back pain, and bones breaking more easily. Food supplements in Ireland have been exempt of VAT, until now, following a review by the Irish Government. The Revenue Commissioners have decided this special concession should no longer be applied to food supplements. “This is a tax on the health of the people of Ireland,” said Mr Ronan. “It is a tax on the elderly, the young and the vulnerable.” Defending the decision, Labour Party leader Brendan Howlin explained, "The way I had been aiming to deal with the matter was through the Tax Advisory Group which publishes papers on topics like this each summer that allow the Government and stakeholders to explore how this issue can be dealt with.”


DONâ&#x20AC;&#x2122;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.


eMental health: New opportunities and roles for pharmacists and community pharmacies?

I

reland has one of the highest rates of mental health illness in Europe. Pharmacists are in prime positions to interact with and assist in caring for those with mental health issues. In advance of World Mental Health Day (October 10), this article takes a closer look at the opportunities for community pharmacists within the eMental health context in Ireland.

The emergence of the internet, smartphones, social media and other technology-based developments have prompted many innovations in healthcare. Within the mental health field, these developments are now commonly referred to as eMental health. A recent review identified a range of eMental health application domains:1 • Telemental health (enabling consultations at a distance) • eTherapy (online therapeutic programmes) • Ongoing support for enduring mental health difficulty (e.g. for medication management) • Other innovative additions to the treatment toolkit (e.g. virtual reality, serious gaming) • Crisis support and suicide prevention (e.g. crisis text services) • Information and psychoeducation (online self-help) • Peer support (online groups and other applications of social media). The Department of Health and the HSE have been encouraging development and deployment of eMental health as part of the ongoing efforts to better address mental health challenges in Ireland. These include new ways to overcome limited availability of key mental health professionals, for example, the use of telepsychiatry (using videoconferencing) to provide access to child psychiatrists to support local Child and Adolescent Mental Health teams. Online therapeutic programmes for conditions such as depression are another area under development. These may enable many more people to access therapies like cognitive behavioural therapy (CBT) than would otherwise be possible. HSE also provides online information and sign-posting through its revamped yourmentalhealth.ie website.

“Although the role of pharmacists in care pathways and the wider mental healthcare ecosystem in Ireland requires further clarification and discussion, analysis of the opportunities presented by eMental health may help to identify practical ways to expand and enhance their role” eMental health developments in Ireland.2 Mental Health Reform (the national coalition on mental health) is the Irish partner in the project, with HSE providing the co-financing alongside the Interreg part-funding. eMEN also has partners from the Netherlands, Belgium, UK, France, and Germany, with involvement of a mix of mental health service providers, eMental health developers, researchers and other organisations. One part of the Irish team’s work has been examining the ways eMental health may be of relevance in different parts of the overall mental healthcare ecosystem in Ireland. Domains examined include the role of third sector (non-profit) organisations, as well as the potential to address mental health needs in specific settings such as in third level education and in the workplace.

The eMEN project

New opportunities and roles for pharmacists and community pharmacies?

The eMEN Interreg project is playing an important role in

For this article, the Irish team has prepared an overview of some

18 | PHARMACYNEWSIRELAND.COM

ways that eMental health may have direct relevance for pharmacists and community pharmacies in this country. The recent Pharmaceutical Society of Ireland report Future Pharmacy Practice in Ireland: Meeting Patients’ Needs identifies various ways that pharmacies (and pharmacists) are already involved in mental healthcare and support, as well as aspects of this role that could be enhanced or expanded.3 These include: mental health information and awareness; medicines management in primary and non-acute care; medicines reviews in nursing homes; home care; and specialist pharmacists providing support to other parts of the system. Internationally, the role of pharmacists in community mental healthcare is more developed in some jurisdictions than in Ireland4, and eMental health is playing a role in this context. Evidence on the effectiveness of telehealth models for pharmacists providing outpatient mental healthcare care is emerging, for example, for improving depression outcomes.5 In the United States, pharmacy and pharmacist regulations now cover telepharmacy and identify a number of types of service.6 In practice, telepharmacy is becoming an important approach for providing clinical pharmacist expertise to rural areas. This involves connecting the clinical pharmacist to a remote site using audio-visual conferencing, enabling remote consultation and advice on medication management. For example, the Veterans Administration has an active rural telepharmacy programme that focuses on a number of priority health themes, including mental health.7 There is also growing awareness and activity in exploiting the broader potential of telepharmacy within the pharmacy space. A recent review identified a range of applications to expand healthcare outside the walls of the retail pharmacy whilst complementing and enhancing their existing services.8 Areas identified include: customerinitiated consultations (including

out-of-hours medication advice); pharmacist-initiated consultations (e.g. for support with complex medication regimes); pharmacistto-pharmacist consultations (e.g. access to more experienced or specialist clinical pharmacists); connecting pharmacists to care management teams; and on-demand care via in-store telehealth kiosks. In Scotland, a telepharmacy innovation originating in the NHS Highlands to address needs in sparsely populated rural areas is now also seen to have much wider potential. The ‘Pharmacy Anywhere’ project began in 2017 and has two elements: ‘Vision Anywhere’ - an app that gives pharmacists shared (remote) access to patients’ medical records; and ‘Attend Anywhere’ - a web-based video consulting system that enables patients have a consultation at home via an internet-connected computer or smartphone.9 GPs identify patients due for medication review and make a (virtual) appointment for them with the pharmacist; at the end of the consultation, the pharmacist updates the patient’s medical record, makes any necessary changes to their medications, and transmits the information back to the GP practice system. More generally in Scotland, the recent government strategy for pharmaceutical care gives considerable attention to digital information and technologies.10 This includes ePharmacy, shared access to electronic records, technology enabled care, and decision support tools. In Ireland, there have been some pilots or local innovations in telepharmacy and in telehealth access from pharmacies, although not yet focusing specifically on mental health. One example involves access to an online doctor service from a pharmacy’s consulting room.11 Supporting greater patient involvement and shared decision-making Modernisation and reform of mental healthcare services is an ongoing process in Ireland. The current policy framework (A


Vision for Change12) and the HSE’s National Recovery Framework13 emphasise the importance of supporting greater client involvement and shared decisionmaking in all aspects of their treatment and recovery. A national survey of mental health service users found decisions around medication are often a central component of this.14 Community pharmacists could play an enhanced role in this area. For example, along with prescribing and other healthcare professionals involved, pharmacists could provide specific support and engagement for clients starting (trying out) antidepressant medications; they could also have a specific role in ongoing support and engagement for clients using psychotropic medications. Apart from helping clients to make optimal decisions around outcomes important for them in the context of their mental health difficulties, pharmacists also have a potentially significant role in addressing mental and physical health co-morbidities. One example of eMental health to support shared decisionmaking and management around psychiatric medication is the ‘Common Ground’ initiative from the United States. This involves a combination of computer-based decision support software and peer support workers to support people before, during, and after a consultation on psychiatric medication.15 More generally, mobile apps are increasingly targeting support

for users in self-management of their mental health16, including medication management and adherence improvement.17 Pharmacists may come to have an important role in helping clients navigate this area, and to select suitable and good quality tools for their purposes. Although the role of pharmacists in care pathways and the wider mental healthcare ecosystem in Ireland requires further clarification and discussion, analysis of the opportunities presented by eMental health may help to identify practical ways to expand and enhance their role. Meanwhile, some Irish pharmacies and pharmacists are already beginning to identify uses of telehealth to provide value-added services, and the possibilities presented by eMental health in this space warrant further attention. Kevin Cullen, Scientific Lead, Mental Health Reform (eMEN project) Further information about the eMEN project in Ireland: https://www.mentalhealthreform.ie/ projects/emen-project/ References Cullen K (2018) eMental health: State-of-the-art & opportunities for Ireland. https://www. mentalhealthreform.ie/wp-content/ uploads/2018/10/eMental-HealthState-of-the-art-Opportunities-forIreland-Full-Report.pdf 2 https://www.mentalhealthreform.ie/ projects/emen-project/ 3 The Pharmaceutical Society of 1

Ireland (2016) Future Pharmacy Practice in Ireland: Meeting Patients’ Needs. https://www.thepsi.ie/ Libraries/Pharmacy_Practice/ PSI_Future_Pharmacy_Practice_in_ Ireland.sflb.ashx Rubio-Valera M, Chen T, O’Reilly C (2014) New roles for pharmacists in community mental health care: a narrative review. International Journal of Environmental Research and Public Health, 2014, 11, 1096710990.

4

Littauer S, Dixon D, Mishra V, Sisson E, Salgado T (2017) Pharmacists providing care in the outpatient setting through telemedicine: a narrative review. Pharmacy Practice 2017, Oct-Dec; 15 (4); 1134

5

Compton-Brown A and Mooradian S (2016) State Regulation of Telepharmacy. Pharmacy Times, March 23, 2016. https://www. pharmacytimes.com/news/stateregulation-of-telepharmacy

6

Traynor K (2017) VA project expands clinical pharmacy services to rural veterans. American Journal of Health-System Pharmacy, Volume 74, Issue 5, 1 March 2017, Pages 274-275

7

Kosowsky J (2015) The potential for telehealth within the pharmacy space. Directions in Pharmacy, August 20, 2015. https://www. pharmacytimes.com/publications/ directions-in-pharmacy/2015/ august2015

8

Pike H (2018) Web therapy: how pharmacists are leading the way in telehealth. The Pharmaceutical Journal, 9 Aug 2018.

9

Scottish Government (2017) Achieving Excellence in Pharmaceutical Care: A Strategy

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for Scotland. https://www.gov.scot/ publications/achieving-excellencepharmaceutical-care-strategyscotland/ https://www.rte.ie/news/ business/2018/0711/977953-videodoc-mccabes-deal/

11

Department of Health (2006) The Report of the Expert Group on Mental Health Policy – A Vision for Change. https://health.gov.ie/blog/ publications/the-report-of-theexpert-group-on-mental-healthpolicy-a-vision-for-change/

12

HSE (2018) A National Framework for Recovery in Mental Health. https://www.hse.ie/eng/services/ list/4/mental-health-services/ advancingrecoveryireland/nationalframework-for-recovery-in-mentalhealth/recovery-framework.pdf

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O’Féich P, Mitchell K, Pérez S, McDaid S (2019) My Voice Matters: Report on a NationalConsultation withMental HealthService Users. https://www.mentalhealthreform.ie/ wp-content/uploads/2019/03/SUMAIN-WEB.pdf

14

Deegan P (2010) A web application to support recovery and shared decision making in psychiatric medication clinics. Psychiatric Rehabilitation Journal, 2010, Volume 34, No. 1, 23-28.

15

Depp C, Moore R, Perivoliotis D, Granholm E (2016) Technology and self-management in serious mental illness. Dialogues in Clinical Neuroscience – Vol 18, No. 2, 171

16

Choi A, Lovett A, Kang J et al (2015) Mobile applications to improve medication adherence: existing apps, quality of life and future directions. Advances in Pharmacology and Pharmacy 3(3): 64-74. 17

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Calls for reduction in drug payment scheme Unlock savings of €50m by increasing use of biosimilars. The Government needs to stand up for cancer patients and back up its own commitments with the necessary investment. This is the overarching call from the Irish Cancer Society in its Budget 2020 submission. The Society is calling for, amongst other issues raised, a reduction in the Drugs Payment Scheme threshold from ¤124 a month to ¤100 for families and ¤72 for single people; and the removal of the prescription charge for medical card holders (currently ¤2 per item up to a maximum of ¤20). According to the Society’s Chief Executive Averil Power, there is clear public support for such measures. “In a survey recently carried out by Core Research, almost 3 in 4 people supported the removal of inpatient charges while 6 in 10 said the drug payment scheme threshold should be reduced.

“It also found those on medical cards often don’t take all their medication because they can’t afford prescription charges. More than 1 in 2 chose to pay for their child’s medication ahead of their own. Unable to afford essential medicines, such as anti-nausea tablets, patients’ suffer far worse side effects from their cancer treatment than they should. This is incredibly unfair and must be addressed”, she said. “Many families suffer a big drop in income when someone gets cancer. At the same time, they have to pay for everything from chemotherapy appointments to anti-nausea medication and hospital parking charges. With extra costs of up to ¤1,200 a month, they find themselves under siege financially while also trying to manage the physical and psychological burden of having cancer.”

The Irish Cancer Society wants to stop preventable cancers and for patients who do get cancer to have best in class treatment and care. One of the measures proposed to this, according to the Society, is to unlock savings of ¤50m by increasing use of biosimilars. The submission states that not only have resources not been given to the National Cancer Control Programme in 2019 to deliver new initiatives promised in the National Cancer Strategy, but inadequate funding has been provided to deliver existing services to a growing number of cancer patients. This includes areas such radiotherapy, rapid access clinics and diagnostics, and has directly impacted cancer patients. “In Budget 2020, we need to see

fresh investment to set cancer services back on the right path, to ensure patients are diagnosed in the right place at the right time, and to make sure that every patient has the opportunity to access the best possible care and treatment. “We know that with the right supports and investment, we can reduce the number of cancers being diagnosed, catch cancers at their earliest possible stage and, as a result, save lives,” says the report. Supporting the full implementation of the National Cancer Strategy and the Sláintecare report and implementation plans can dramatically improve care, significantly reduce waiting times for vital cancer tests and support the growing number of health professionals needed to support a growing and ageing population.

Providing a ‘Haven’ for Charitable Causes Haven Pharmacy ladies recently took part in the VHI Women’s Mini Marathon, raising €2,820 for CRY (Cardiac Risk in the Young) Ireland. 

The Haven Pharmacy Ladies who took part in the VHI Women’s Mini Marathon for CRY Ireland

Owen Daly, Pharmacist, Haven Pharmacy Tralee; Joe Hennebery Chairman, Kerry Hospice; Helena Rusk, Pharmacist, Haven Pharmacy Tralee and Mary Shanahan, Kerry Hospice Secretary 

This brings the Haven Pharmacy total for fundraising to over ¤30,000 in the first 6 months of 2019 thanks to the incredibly generous staff and customers who have donated funds to Childline, Temple Street, Irish Cancer Society, Kerry Hospice and Beaumont Hospital Foundation. Haven’s co-operative ethos is to help to improve the health and well-being of patients and customers in their local communities and this is underpinned by their members efforts in fundraising for charities across Ireland.

Sophie Hart, Keith Brennan and Denise Carroll from Haven Pharmacy with Paddy Delaney and Sarah-Louise McEvoy from Beaumont Foundation

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NEW Relizema™ ECZEMA DRY & SENSITIVE SKIN BABY CARE

A unique range of Italian emollients and cleansers, which includes products developed for eczema, dermatitis, baby care, dry and sensitive skin.

ORDER NOW OMAURA CRONIN

086 – 8198271 Maura.Cronin@united-drug.com

MERVYN CONNAUGHTON

086 – 8198271 Mervyn.Connaughton@united-drug.com

YVONNE QUIGLEY

087 - 0524507 Yvonne.Quigley@united-drug.com

All products are dermatologically tested

Distributed by: A.Menarini Pharmaceuticals Ireland Ltd, Castlecourt, Monkstown Farm, Monkstown, Glenageary, Co. Dublin.

www.relife.ie

IE19031 IR-REL-49-2019 Date of item August 2019


22

News

Keane’s aim for Pharmacy ‘first’ Keane’s CarePlus Pharmacy are currently undertaking training to with AsIAm to become Ireland’s first certified Autism Friendly Pharmacy.

Selenium the vanishing micronutrient? Whilst many have not heard of selenium, this essential micronutrient could be vanishing from the Irish consumers diet. Selenium is an essential mineral, meaning it must be obtained through diet. It’s only needed in small amounts but plays a major role in important processes in the body, including metabolism and thyroid function.

AsIAm is an organisation working to build a more inclusive Ireland for the autism community. Their remit ranges from providing a portal of information about autism, to serving as a platform for autistic

people and their families to share stories and experiences, to providing a strong voice for the concerns of the community and educating society.

Keane’s CarePlus Pharmacies are currently undertaking training with AsIAm under the leadership of Robert and John Keane, owners and Pharmacists – pictured far left

Pharmacy can plug online health advice gap As new research shows increasingly more Irish people are seeking health information or advice online, the critical role community pharmacists play within the wider healthcare agenda becomes even more clear. A study carried out by Behaviour & Attitudes on behalf of the Royal College of Surgeons of Ireland (RCSI) has highlighted that 50% of Irish people seek health information or advice online. The community pharmacy often becomes the de facto community health centre, with pharmacists acting as the first point of care and therefore it is important you identify and educate those with health concerns. The research comes as RCSI launch a series of public lectures addressing common illnesses and health related topics. The research also found that:  1 in 5 Irish adults have never spoken to a healthcare professional about health concerns  Mental health is cited as parents’ main health concern for their children.

 Adults under 25 are least likely to speak to a healthcare professional about health concerns.  Cancer is women’s main health concern, followed by mental health, heart disease and stress.  2 in 5 women under 35 rate stress in their top three health concerns and 1 in 8 are concerned about fertility issues.  Despite many turning to the internet for health information, 69% of the Irish public do not consider websites to be a trusted source. Commenting on the findings, Professor Hannah McGee, Dean of the Faculty of Medicine and Health Sciences RCSI, says, “As educators and researchers, it is our responsibility to use our expertise, knowledge, and discoveries to foster improvements in health and education in our communities, our societies and around the world. The RCSI MyHealth Lecture series

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aims to do just that – to de-mystify the common health concerns affecting the Irish public, drawing expertise and insight from our team of researchers, and leading international health experts at the cutting edge of medical and healthcare developments.” Running throughout the year, the RCSI MyHealth lecture series will explore a wide range of areas in health and wellbeing, including mental health, arthritis, vaccinations and psychology. Upcoming lectures include:  Cannabis and Youth Health – The Evidence 18 September 2019  Arthritis: My Joint Health 3 October 2019  How Inequality Kills: Margins, the Marginalised and Public Health – 19 November 2019  The Evidence behind Vaccinations - 3 March 2020  Positive Psychology 21 May 2020

Selenium has attracted attention because of its antioxidant properties. It is an essential micronutrient that both humans and animals need for maintaining good health. Everyone has in their body a number of selenium-dependent enzymes (selenoproteins) that cannot function properly without the presence of this mineral. Selenoproteins must be saturated with selenium in order to perform their tasks, which include: • ensuring normal function of the thyroid gland • supporting a normal immune function • contributing to normal hair and nails • maintaining normal sperm cell production • protecting cells against oxidative stress Scientists from Rothamsted Research warn that levels of selenium in the soil could drop by more than 10% in the future due to climate change and a number of other factors. For example, the average selenium intake in Great Britain has been reduced by around 50% in the past four to five decades as a result of declining selenium levels in the diet, and the nutrient depletion of agricultural soil expected in the future will only make the problem worse. Selenium experts generally agree that a daily intake level of around 100-125 micrograms of selenium is sufficient. A way of dealing with low intake levels in the food is to take a supplement, preferably in the form of organic selenium yeast that has good absorption and bioavailability.


Nu

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Paperless Medication Management The MAMA Mobile Application is setting the standard within the healthcare sector in Ireland and the UK for medication administration management by making the move to a paperless environment a reality. Pharmacists, Nursing Homes and Doctors can now all work in tandem to deliver the highest levels of care for patients while maintaining the most rigourous compliance standards. MAR Charts and Cardex created during medication rounds are now all stored and signed electronically providing highly dynamic reporting, simplifying audit requirements and reducing costs significantly. Call us on 049-899-5000 to find out more about this revolutionary solution.

Main Street Virginia, Co. Cavan, Ireland

00-353-49-899 5000 www.virginiamedical.ie


24

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Evolving Role of Pharmacy reflected in new Guidance Community pharmacists across Ireland are being encouraged to register and attend several nationwide information events being held by the Pharmaceutical Society of Ireland (PSI). The events are designed to offer insights into the new Pharmacy Code of Conduct being launched officially at the end of this month (September). health, wellbeing, care and safety of patients. The Code is intended to support pharmacists working in modern Ireland and has taken into account changes in Irish healthcare legislation and society. The new Code will be launched on 25 September 2019 to coincide with World Pharmacist Day and all pharmacists will receive a copy of the new Code in early September, and it will be published on the website. Information events on the updated Code of Conduct: To support pharmacists with the role out of the updated Code, PSI will be holding seven information events across the country in September and October.

A review of the Code of Conduct for Pharmacists commenced in 2017. The current Code is in place since 2009 and the review was undertaken to ensure it continues to reflect the current environment, the evolving role of pharmacists and a changing health service. This review involved a substantial process of research and engagement with pharmacists, stakeholders and the public. In 2017, PSI invited a wide range of feedback on the Code to help them consider any changes that might be needed in a revised Code. Following this consultation, and engagement with relevant experts, the Code was revised and updated, and a public

consultation was carried out in August 2018. The updated Code was approved by the Minister for Health earlier this year and will come into effect on 21 October 2019. Updated Code of Conduct (2019): The updated Code acknowledges the changes that have taken place in the delivery of healthcare in recent years, the evolving role of pharmacists and the exercise of professional judgement by pharmacists in the fulfillment of their professional responsibilities to patients and the public. The updated Code applies to all pharmacists and is more distinctly patient centered than the original Code, focusing on ensuring that all pharmacists practice in a way that maintains and improves the

Each information event will focus on one of the seven principles contained in the Code, and will provide an opportunity to hear from, and engage with, pharmacists and guest speakers who work across a variety of areas. Pharmacists can sign up to attend the information events using the online form at www.thepsi.ie. Other useful resources will also be made available on the PSI website following the events.

Dates and locations • Dublin City, 25 and 26 September 2019 • North Dublin, 1 October 2019 • Galway, 2 October 2019 • Cork, 8 October 2019 • Limerick, 9 October 2019 • Athlone, 10 October 2019

The Pharmacy Show The Pharmacy Show is taking place on Sunday the 6th and Monday 7th of October 2019 at the NEC in Birmingham. The Pharmacy Show is the only event that is pulling out all the stops to help pharmacists. Join pharmacy experts and key opinion leaders, new and existing suppliers and policy makers to keep up with all latest developments, grow your business, improve patient outcomes and get all the practical training and advice you need. Visit www.thepharmacyshow.co.uk for further information.

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Vitamin D not linked to low blood pressure Researchers from The Irish Longitudinal Study on Ageing (TILDA) at Trinity College have shown in the largest study to-date that vitamin D is not associated with low blood pressure on standing (orthostatic hypotension) in older adults. (OH) is a common chronic condition estimated to affect over 30% of older adults. It is characterised as a significant drop in blood pressure upon standing and has been associated with falls, fractures and mortality. Recent research has suggested that vitamin D may have benefits for this condition. Vitamin D is essential for bone metabolism and is thought to have beneficial health effects for muscle strength and health. High levels of vitamin D deficiency exist in the older Irish population with 1 in 8 deficient and 1 in 4 deficient during the winter period due to the lack of any food fortification policy in Ireland. Key findings: • Older adults with vitamin D deficiency were more likely to be smokers, take high blood pressure medication and have higher levels of cardiovascular disorders compared to those with sufficient vitamin D status. • Those with low vitamin D status were no more likely to have OH than those with normal vitamin D levels. • Vitamin D supplement use was not associated with OH. Principal Investigator of TILDA, Professor Rose-Anne Kenny said, “Although we have seen no association, the usefulness of vitamin D in the management and possibly the prevention of OH cannot be dismissed. For example, those with OH are more likely to fall and also sustain fractures and the strongest evidence for the health benefits for vitamin D exists for bone health and muscle function. Thus, checking vitamin D levels and optimising vitamin D status for bone health and muscle function is important in this high risk group.”


Budesonide/Formoterol Easyhaler

Maintenance and Reliever Therapy

1. SHAKE

2. CLICK

3. INHALE

5 MIN

LESS THAN 5 MIN TO MASTER.1

Prescribing Information Bufomix Easyhaler 80 mcg/4.5 mcg, 160 mcg/4.5 mcg and 320 mcg/9.0 mcg/inhalation, inhalation powder (budesonide/ formoterol fumarate dihydrate) Indication: Asthma All strengths: Bufomix Easyhaler is indicated in adults and adolescents aged 12-17 years, for the regular treatment of asthma where use of a combination (inhaled corticosteroid and long-acting ß2 adrenoceptor agonist) is appropriate: patients not adequately controlled with inhaled corticosteroids and “as needed” inhaled short acting ß2 adrenoceptor agonists or patients already adequately controlled on both inhaled corticosteroids and long acting ß2 adrenoceptor agonists. Bufomix Easyhaler 80 mcg/4.5 mcg: is also indicated for asthma in children aged 6 years and older; not appropriate in patients with severe asthma. COPD 160 mcg /4.5 mcg and 320 mcg /9.0 mcg: Symptomatic treatment of patients with severe COPD (FEV1 < 70% predicted normal) and a history of repeated exacerbations, who have significant symptoms despite regular therapy with long acting bronchodilators. Dosage and Administration: Asthma Not intended for the initial management of asthma. The dosage of the components is individual and should be adjusted to the severity of the disease; Maintenance therapy: Advise patients to have their separate rapid acting bronchodilator available for rescue use at all times. Increasing use of a separate rapid-acting bronchodilator warrants a reassessment of the asthma therapy. Bufomix Easyhaler 80 mcg/4.5 mcg and 160 mcg/4.5 mcg: Adults (18 years and older): 1-2 inhalations twice daily, up to a maximum of 4 inhalations twice daily. Adolescents (12- 17 years): 1-2 inhalations twice daily. Children (6-11 years): Bufomix Easyhaler 80 mcg/4.5 mcg 2 inhalations twice daily. Bufomix Easyhaler 160 mcg/4.5 mcg is not recommended for children under 12 years. Bufomix Easyhaler 320 mcg/9 mcg: Adults (18 years and older): 1 inhalation twice daily, up to a maximum of 2 inhalations twice daily. Adolescents (12–17 years): 1 inhalation twice daily. Bufomix Easyhaler 320 mcg/9 mcg should be used as maintenance therapy only, and is not recommended for children under 12 years. All strengths: When control of symptoms is achieved with the twice daily regimen, titration to the lowest effective dose could include once daily use, when a long acting bronchodilator would be required to maintain control. Maintenance and reliever therapy: Advise patients to always have Bufomix Easyhaler available for rescue use at all times. Monitor closely for dose-related adverse effects in patients who frequently take high numbers of Bufomix Easyhaler as-needed inhalations. Bufomix Easyhaler 80 mcg/4.5 mcg and 160 mcg/4.5 mcg: Adults and adolescents (12 years and older): Usually 2 inhalations daily; for 160mcg/4.5mcg only, a maintenance dose of 2 inhalations twice daily may be appropriate. 1 additional inhalation as needed in response to symptoms; if symptoms persist after a few minutes, an additional inhalation should be taken, maximum 6 inhalations on any single occasion. A total daily dose of more than 8 inhalations is not normally needed; however, a total daily dose of up to 12 inhalations could be used for a limited period. Patients using more than 8 inhalations daily should be strongly recommended to seek medical advice. Children under 12 years: maintenance and reliever therapy not recommended. COPD Bufomix Easyhaler, 160 mcg/4.5 mcg: Adults: Two inhalations twice daily. Bufomix Easyhaler 320 mcg/9mcg: Adults: 1 inhalation twice daily. Contraindications: Hypersensitivity to budesonide, formoterol or lactose. Warnings and Precautions: Taper dose when the treatment is discontinued. Patients should seek medical attention if treatment is ineffective, or they exceed the highest recommended dose of Bufomix Easyhaler. Reassess if dose of rescue bronchodilators increases. Sudden and progressive deterioration in control of asthma or COPD is potentially life threatening and the patient should undergo urgent medical assessment. Patients should be advised to have their rescue inhaler available at all times. Remind patients to take their maintenance dose, even when asymptomatic. Once asthma symptoms controlled, consideration may be given to gradually reducing the dose. Regular review of patients as treatment is stepped down is important. The lowest effective dose should be used. Do not initiate during an exacerbation, or significantly worsening or acutely deteriorating asthma. Serious asthma-related adverse events and exacerbations may occur during treatment. Patients should continue treatment but seek medical advice if asthma symptoms

remain uncontrolled or worsen. Paradoxical bronchospasm may occur. Not intended for regular prophylactic use, e.g. before exercise. Systemic effects may occur with any inhaled corticosteroid, particularly at high doses prescribed for long periods. Visual disturbance may be reported with corticosteroids, consider referral to an ophthalmologist for symptoms such as blurred vision or other visual disturbances. Potential effects on bone density should be considered, particularly in patients on high doses for prolonged periods that have coexisting risk factors for osteoporosis. If adrenal function is impaired from previous systemic steroid therapy, care should be taken when transferring patients. Oral steroid dependent patients transferred to inhaled budesonide may remain at risk from impaired adrenal function for some time, regularly monitor HPA axis function. Prolonged treatment with high doses of inhaled corticosteroids may result in clinically significant adrenal suppression. Consider additional systemic corticosteroid cover during periods of stress. Rapid reduction in the dose of steroids can induce acute adrenal crisis. Do not stop abruptly. During transfer from oral therapy a generally lower systemic steroid action will be experienced which may result in the appearance of allergic or arthritic symptoms. Specific treatment should be initiated for these conditions. A general insufficient glucocorticosteroid effect should be suspected if, in rare cases, symptoms such as tiredness, headache, nausea and vomiting should occur. To minimise risk of oropharyngeal candida infection, patients should rinse their mouth with water after inhaling the maintenance dose. Avoid concomitant treatment with itraconazole, ritonavir or other potent CYP3A4 inhibitors. Administer with caution in patients with thyrotoxicosis, phaeochromocytoma, diabetes mellitus, untreated hypokalaemia, hypertrophic obstructive cardiomyopathy, idiopathic subvalvular aortic stenosis, severe hypertension, aneurysm or other severe cardiovascular disorders, such as ischaemic heart disease, tachyarrhythmias or severe heart failure. Caution when treating patients with prolongation of the QTc interval. Special care needed in patients with active or quiescent pulmonary tuberculosis, and fungal and viral infections in the airways. Potentially serious hypokalaemia may result from high doses of β2 adrenoceptor agonists; this may be potentiated by hypoxia and concomitant treatment with xanthine-derivatives, steroids and diuretics; use particular caution in acute severe asthma, monitor serum potassium levels. Additional blood An increased incidence of pneumonia, including pneumonia requiring hospitalisation, has been observed in patients with COPD receiving inhaled corticosteroids, so physicians should be vigilant for the possible development of pneumonia. glucose controls should be considered in diabetic patients. Contains lactose. The amount does not normally cause problems in lactose intolerant people. The excipient lactose contains small amounts of milk proteins, which may cause allergic reactions. Paediatric population: Regularly monitor the height of children receiving prolonged treatment; consider referring the patient to a paediatric respiratory specialist. Undesirable Effects: The most common drug related adverse reactions, such as tremor and palpitations, tend to be mild and usually disappear within a few days of treatment. Common (≥ 1/100 to < 1/10), candida infections in the oropharynx, pneumonia (in COPD patients), headache, tremor, palpitations, mild irritation in the throat, coughing, hoarseness. Uncommon ( 1/1000 to < 1/100), aggression, psychomotor hyperactivity, anxiety, sleep disorders, dizziness, vision blurred, tachycardia, nausea, bruises, muscle cramps. Rare ( 1/10 000 to < 1/1000), Immediate and delayed hypersensitivity reactions, hypokalaemia, cardiac arrhythmias, bronchospasm. Very rare (< 1/10 000), Cushing’s syndrome, adrenal suppression, growth retardation, decrease in bone mineral density, hyperglycaemia, depression, behavioural changes (predominantly in children), taste disturbance, cataract and glaucoma, angina pectoris, prolongation of QTc interval, variations in blood pressure. Legal Category: POM S1B. Product Authorisation Numbers: Bufomix Easyhaler 80 mcg/4.5 mcg/inhalation, inhalation powder, PA1327/015/004 Bufomix Easyhaler, 160 mcg/4.5  mcg/inhalation, inhalation powder, PA1327/015/002; Bufomix Easyhaler, 320 mcg/9 mcg/inhalation, inhalation powder, PA1327/015/003. Distributed by: Orion Pharma (Ireland) Ltd. c/o Allphar Services Ltd, 4045 Kingswood Road, Citywest Business Park, Co Dublin, Ireland . Full prescribing information is available on request. Bufomix Easyhaler is a registered trademark. Date of Prescribing Information: December 2018.

REFERENCES 1. Tamási L, Szilasi M, Gálffy G. Clinical Effectiveness of Budesonide/Formoterol Fumarate Easyhaler® for Patients with Poorly Controlled Obstructive Airway Disease: a Real-World Study of Patient-Reported Outcomes. Adv Ther 2018;35(8):1140–52.

Date of Item: July 2019 /Code EASYH-438


Landmark Changes in Asthma

A

sthma is the most common chronic disease affecting the Irish population. Amongst primary healthcare professionals, pharmacists are the most accessible and this places pharmacists in an excellent position to play a role in the management of asthma.

Globally, trials of many community pharmacy-based asthma care models have provided evidence that pharmacist delivered interventions can improve clinical, humanistic and economic outcomes for asthma patients. 470,000 people in Ireland currently have asthma, including one in five children. One person dies every week as a result of the condition, and of these deaths 90% are preventable. The disease also accounts for over 5,000 hospital admissions every year.

technique checked by a healthcare professional at every opportunity. More recently, the Irish Pharmacy Union teamed up with the Asthma Society of Ireland to launch an ‘Inhaler Technique’ awareness campaign in order to encourage people with asthma to ensure that they are using their inhaler device correctly. “More than one person dies every week in Ireland from asthma and 90 per cent of these deaths are preventable. It is estimated that

over half of people with asthma in Ireland are not consistently using their device correctly,” Asthma Society chief executive Sarah O’Connor says. Landmark Changes in Asthma Management The Global Strategy for Asthma Management (GINA) recently updated its Pocket Guide for Asthma Management and Prevention (April 2019). The 2019 GINA strategy report represents the most significant

change in asthma management in over 30 years. The key changes in GINA 2019 are first, that for safety, GINA no longer recommends starting treatment of asthma with short-acting beta2agonist reliever inhalers on their own. Instead, GINA recommends that all adults and adolescents with asthma should receive either symptom-driven (for mild asthma) or daily inhaled anti-inflammatory controller treatment, to reduce their

Better Outcomes Inhalers are one of the most common devices used to treat asthma yet research shows as many as 2 in 3 people may be using their inhaler incorrectly.

Table 1: Asthma Triggers

However, when taught the correct technique, people are able to use their inhalers more effectively with substantial benefits for their asthma control and overall health. People with asthma are advised to have the inhaler

Stress

Respiratory infection Physical activity, including exercise

Exposure to cold air or sudden changes in temperature Exposure to irritants such as cigarette smoke, air pollution, chemicals, dust, or aerosol sprays Allergens such as mould, pollen, dust mites, and pet dander

26 | PHARMACYNEWSIRELAND.COM


flutiform® k-haler® (fluticasone propionate/formoterol fumarate) 50 μg/5 μg and 125 μg /5 μg pressurised inhalation suspension. Prescribing Information Republic of Ireland Please read the Summary of Product Characteristics (SPC) before prescribing. Presentation Pressurised inhalation suspension, in a breath-actuated pressurised aerosol inhaler. Indications Regular treatment of asthma where the use of a combination product (inhaled corticosteroid [ICS] and long-acting β2-agonist [LABA]) is appropriate: (i) for patients not adequately controlled with ICS and ‘as required’ inhaled short-acting β2-agonist (SABA) (ii) for patients already adequately controlled on both an ICS and a LABA. For adults and adolescents aged 12 years and above. Dosage and administration for inhalation use. Patients should be shown how to use the inhaler correctly by a healthcare professional. Patients should be given the strength of flutiform k-haler containing the appropriate fluticasone propionate dose for their disease severity (50 μg/5 μg per actuation is not appropriate in patients with severe asthma). The appropriate strength should be taken as two inhalations, twice daily (normally morning and evening) and used every day, even when asymptomatic. flutiform k-haler is not recommended in children under 12 years. Prescribers should be aware that in asthmatics, fluticasone propionate is as effective as some other inhaled steroids when administered at approximately half the total daily microgram dose. Patients should be assessed regularly and once asthma is controlled, treatment should be reviewed and stepped down to the lowest effective dose, or an ICS alone. ICSs alone are first line treatment for most patients. flutiform k-haler is not intended for initial treatment of mild asthma. For patients with severe asthma the ICS therapy should be established before prescribing a fixeddose combination product. Patients on flutiform k-haler must not use an additional LABA. An inhaled SABA should be taken for immediate relief of asthma symptoms arising between doses. Patients should be advised to contact their prescriber when flutiform k-haler dose counter is getting near zero. Contra-indications Hypersensitivity to the active substances or to any of the excipients. Precautions and warnings flutiform k-haler should not be used as the first asthma treatment, to treat acute asthma symptoms or for prophylaxis of exercise-induced asthma. It should not be initiated during an exacerbation, during significantly worsening or acutely deteriorating asthma, and should not be stopped abruptly. If a patient experiences serious asthma-related adverse events or exacerbations, they should continue treatment and seek medical advice. Patients should be reviewed as soon as possible if there is any indication of deteriorating asthma control. In case of sudden and progressive deterioration, seek urgent medical assessment. Caution in patients with: pulmonary tuberculosis; quiescent tuberculosis; fungal, viral or other infections of the airway; thyrotoxicosis; phaeochromocytoma; diabetes mellitus (consider additional blood sugar controls); uncorrected hypokalaemia; predisposition to low levels of serum potassium; impaired adrenal function (monitor HPA axis function regularly); hypertrophic obstructive cardiomyopathy; idiopathic subvalvular aortic stenosis; severe hypertension; aneurysm or other severe cardiovascular disorders; unstable or acute severe asthma and other conditions when the likelihood for hypokalaemia adverse effects is increased. There is risk of potentially serious hypokalaemia with high doses of β2-agonists or concomitant treatment with β2-agonists and drugs that can induce or potentiate a hypokalaemic effect. Monitoring of serum potassium levels is recommended during these circumstances. Formoterol may induce prolongation of the QTc interval. Caution must be observed when treating patients with existing prolongation of QTc interval. flutiform k-haler should be discontinued immediately if there is evidence of paradoxical bronchospasm. Visual disturbance may be reported with corticosteroid use. Systemic effects with an ICS may occur, particularly at high doses for prolonged periods or when combined with potent CYP3A4 inhibitors, but are less likely than with oral corticosteroids. Possible systemic effects include Cushing’s syndrome, Cushingoid features, adrenal suppression, growth retardation in children and adolescents, decrease in bone mineral density and cataract glaucoma. Children may also experience anxiety, sleep disorders and behavioural changes. Increased exposure can be expected in patients with severe hepatic impairment. Prolonged treatment with high doses of corticosteroids may result in adrenal suppression and acute adrenal crisis, particularly in children and adolescents or potentially as a result of trauma, surgery, infection or rapid dose reduction. flutiform k-haler contains a negligible amount of ethanol that does not pose risk to patients. Interactions Co-treatment with CYP3A inhibitors (e.g. ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nelfinavir, saquinavir, ketoconazole, telithromycin, cobicistat) should be avoided unless the benefit outweighs the increased risk of systemic side-effects. Caution is advised with concomitant use of non-potassium sparing diuretics (e.g. loop or thiazide), xanthine derivatives, glucocorticosteroids, L-Dopa, L-thyroxine, oxytocin, alcohol or other adrenergic drugs, including anaesthesia with halogenated hydrocarbons and digitalis glycosides, β-adrenergic drugs, known to prolong the QTc interval, such as tricyclic antidepressants or MAOIs (and for two weeks following their discontinuation), antipsychotics (including phenothiazines), quinidine, disopyramide, procainamide, antihistamines, furazolidone and procarbazine. flutiform k-haler should not normally be used with β-blockers including those that are used as eye drops to treat glaucoma. Under certain circumstances, e.g. as prophylaxis after myocardial infarction, cardioselective β-blockers could be considered with caution. Pregnancy and lactation flutiform k-haler is not recommended during pregnancy unless the benefits to the mother outweigh risks to the foetus. A risk to the breastfeeding infant cannot be excluded. Side-effects Uncommon (<1/100) but potentially serious: hyperglycaemia, agitation, depression, aggression, behavioural changes (predominantly in children), vision blurred, vertigo, palpitations, ventricular extrasystoles, angina pectoris, tachycardia, hypertension, dyspnoea, peripheral oedema. Please consult the SPC a full list of side-effects and those reported for the individual molecules. Legal category POM Package quantities One inhaler (120 actuations) Marketing Authorisation numbers PA 1688/013/004-005 Marketing Authorisation holder Mundipharma Pharmaceuticals Limited, Millbank House, Arkle Road, Sandyford, Dublin 18, Ireland. Tel: +353 (0)1 2063800. For medical information enquiries, please contact medicalinformation@mundipharma.ie. ® FLUTIFORM is a registered trademark of Jagotec AG, and is used under licence. ® K-HALER is a registered trade mark of Mundipharma AG. © 2018 Napp Pharmaceuticals Limited. Adverse events should be reported to: HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra. ie; E-mail: medsafety@hpra.ie. Adverse events should also be reported to Mundipharma Pharmaceuticals Limited on drugsafetyireland@mundipharma.ie or by phone on 01 2063800 (1800 991830 outside office hours) UK/FLUT-K-18036a(1) Date of Preparation July 2019 IRE/FL-19010a Date of Item September 2019

CMYK - Horizontal

THE K-HALER ASTHMA TREATMENT REDESIGNED

125µ g/5µ g 2 inhalations, twice daily

CMYK - Vertical


risk of serious exacerbations and to control symptoms. New ICS controller options now include:  (for mild asthma) as-needed low dose ICS-formoterol* or if not available, low dose ICS taken whenever SABA is takenƚ  Regular ICS or ICS-LABA every day, plus as needed SABA, or  Maintenance and reliever treatment with ICS-formoterol, with the reliever being low-dose budesonide formoterol or BDP-formoterol. *Off-label; evidence only with budesonide-formoterol; ƚOff-label, combination or separate ICS and SABA inhalers. The new recommendations represent the culmination of a 12year campaign by GINA to obtain evidence for new strategies for treatment of mild asthma. According to the evidence, for best outcomes, ICS-containing treatment should be initiated as soon as possible after the diagnosis of asthma is made. This is because:

adding symptom driven low dose ICS-formoterol containing therapy and is a welcome addition to the GINA guidelines. Backed by a robust evidence base we should expect to see better adherence to controller therapy and a reduction in exacerbations in our patients as a result.” Role of Pharmacy Pharmacists can be instrumental in providing patients with valuable resources to educate them about pharmacologic agents for treating and managing asthma. Pharmacists can educate patients about the proper use of inhalation devices, especially newly diagnosed patients who may be overwhelmed with diagnosis and treatment plans. Considerable effort has been made to decrease inhaler use error, including new advances in inhaler technology, training for pharmacists, and education for patients. Despite those efforts, reviews have found that the occurrence of improper inhaler technique is high and has not improved enough.

Pharmacists should remember that inhaler education is unique, in that assessing technique is needed when patients start a new inhaler and with each returning visit.

patients, coupled with patient education and stressing the importance of patient adherence, is fundamental for effectively controlling asthma.

Questions you may be asked:

Questions to ask:

• What does this medicine do?

• How long have you had asthma like symptoms?

• How will this medicine help? • How long will it take for the medicine to work?

• How frequent are the symptoms and how they affect your quality of life?

• How long will I need to use this medicine for?

• Have you had an attack or recurrent attacks of wheezing?

• How and when should I take this medicine?

• Do you have a troublesome cough at night?

• Should I avoid any other medicines, drinks, foods or activities when I'm taking this medicine?

• Do you wheeze or cough after exercise?

• What should I do if the medicine doesn't agree with me? • Can you check my inhaler technique? As more treatment options and patient resources become available for controlling asthma, a collaborative effort between healthcare professionals and

• Does the patient experience wheezing, chest tightness, or cough after exposure to airborne allergens or pollutants? • Do your colds "go to the chest" or take more than 10 days to clear up? • Are symptoms improved by appropriate asthma treatment? • Is there a family history of asthma?

 Patients with even mild asthma can have severe exacerbations;

Table 2: Factors Affecting Asthma Control

 Low dose ICS markedly reduces asthma hospitalizations and death;

Appropriate medications

 Low dose ICS is very effective in preventing severe exacerbations, reducing symptoms, improving lung function and preventing exercise-induced bronchoconstriction, even in patients with mild asthma.

Developing a written asthma action plan to guide patients in self-management

Dr Brian McCullagh, Respiratory Consultant, from The Mater Hospital Dublin says, “This update is a more patient-centred approach to tackling asthma by

Patient’s willingness to use medications

Identifying asthma triggers Implementing environmental measures to control allergies, irritants, and pollution when feasible Treating co-morbid conditions that may exacerbate asthma, such as allergic rhinitis, gastroesophageal reflux disease, obesity, and sleep apnoea Educating patients about their asthma treatment plan and how to manage their asthma Stressing the importance of patient adherence to the selected treatment plan

News McCauley COO to Trek Las Alpujarras McCauley Health & Beauty Pharmacy Chief Operating Officer Peter Maher is participating in the Galway Hospice 1st International Trek Las Alpujarras 2019 in Spain in October. He is completing the feat with Jane Maher and Cahir Tierney in memory of June Tierney who passed away in April of this year. “The Galway Hospice Foundation gave us so much stolen time with her, allowing us to make so many more memories than we ever thought possible,” they say on their fundraising page. A McCauley Health & Beauty spokesperson says, “We

encourage our employees to pursue their passions outside of the office and we wish him all the best.” If you'd like to help support Peter in his fundraising efforts, please donate to this extremely worthwhile cause by visiting: https://galway-hospice-1stinternational-trek.everydayhero. com/ie/cahir-tierney-jane-maherpeter-maher-s-trek

Peter Maher, Jane Maher and Cahir Tierney will be taking part in the Galway Hospice 1st International Trek Las Alpujarras

28 | PHARMACYNEWSIRELAND.COM


BE PREPARED THIS WINTER

Beat winter colds with the STĂ&#x2030;RIMARTM range of naturally inspired solutions. Made from 100% natural sea water, the STĂ&#x2030;RIMARTM cold range is free from drugs, steroids, preservatives and is suitable for the whole family from 3 years and up.

For more information, POS material or instore training please contact your Pemberton Rep on 01-4632424 cs.pemberton@united-drug.com


Push your Pharmacy First this Winter

W

ith the winter season just around the corner, now is the time for community pharmacists and their teams, to be promoting the message that consumers should visit them first, for advice and treatment of common winter ailments.

Research shows that 18% of GP appointments are for minor ailments. Community pharmacists are in fact, best placed to advise on these conditions and over-thecounter available and appropriate medications.

or because of interactions with other prescription and non- prescription medications. This reinforces the importance of pharmacists, who have been trained to ask the right questions so they can give appropriate advice.

Furthermore, the winter months provide the perfect opportunity for pharmacy to drive home the self-care message and ease the pressure on GP surgeries and A&E departments.

It has been previously revealed that treatment results for common ailments such as coughs and sore throats were equally good regardless of whether patients were treated at a pharmacy, A&E or GP practice, highlighting community pharmacy as a solution to the increasing burden on a stretched health service.

The Government has previously stated that the range of medicines provided without a prescription will continue to expand as part of the drive towards a National Health Service that promotes selfcare and greater public choice. However, self-medication may not be appropriate for every patient in view of preexisting medical conditions

Community pharmacy can have an extremely positive impact on the health of the communities it serves due to the engagement pharmacy teams have with their patients every day. Pharmacists will offer advice on conditions

30 | PHARMACYNEWSIRELAND.COM

and medications, and if appropriate, they will refer a patient to their GP if they feel it necessary.

taking actions to prevent and decrease the likelihood of disease and to restore health after illness or injury.

Emphasis on Self-Care

It is the first step and first choice for Irish people who are taking an increasingly active role in their healthcare and looking to improve their health and wellbeing.

Research indicates that, despite good intentions, many people do not know how to self-treat conditions such as coughs and colds and therefore visit their GP or A&E for advice. Visiting pharmacy as an alternative could save up to 950,000 GP consultations every year. Pharmacies need to be aware of the crucial role they can play in educating customers about relieving symptoms of minor winter ailments.

Research from Behaviour & Attitudes1 confirms that there is a clear desire from the majority of people (92%) to be involved in decisions about their own health and medication, with 80% expressing their view that they see their pharmacist as a key partner in maintaining their health.

Self-care is a healthcare philosophy which emphasises the role of ordinary people in taking ownership of their health and wellbeing and includes

The role of community pharmacists is pivotal to the successful development of selfcare and its more widespread adoption, according to the Irish


Free your customers from the symptoms of hayfever Zirtek Allergy Relief helps to relieve the symptoms of hayfever and urticaria Zirtek Plus Decongestant delivers all the allergy relief of Zirtek with an added decongestant

www.zirtek.ie

ZirtekIE

Zirtek IE

Feel free to place an order with your local rep or customer service team: Call: Email:

01 463 2424 cs.pemberton@united-drug.com

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 Ireland Ltd. Legal Category: OTC. Classification: Zirtek tablets & oral solution: Cetirizine dihydrochloride. Zirtek Plus Decongestant prolonged release tablets: Cetirizine dihydrochloride, Pseudoephedrine hydrochloride. Adverse events should be reported to the Health Products Regulatory Authority at www.hpra.ie or via email to medsafety@hpra.ie Adverse events should also be reported to UCB Pharma Ireland Ltd via email UCBCares.IE@ucb.com Zirtek Allergy Relief is available as an oral solution for 2 years of age and upwards and in tablets suitable for 6 years of age and upwards. Zirtek Plus Decongestant is suitable for adults and adolescents from 12 years of age and upwards.

Cetirizine dihydrochloride Always read the label For further advice please consult your GP or Pharmacist

June IE-P-ZI-ALY-1900047


VITAMIN

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e T hsunshine

vitamin

Contributes to: • maintenance of normal bones • normal function of the immune system • maintenance of normal muscle function MADE IN IRELAND

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Pharmacy Union (IPU) and the Irish Pharmaceutical Healthcare Association (IPHA), who, at the end of last year, launched a self-care awareness campaign, entitled ‘Be Well this Winter – Think Pharmacy’. The campaign was rolled out through the extensive deployment of social media, as well as a series of posters displayed nationwide in retail pharmacies. Winter campaigns are frequently run on an annual basis by many major pharmaceutical companies, encouraging customers to self-care when suffering from colds, flu, sore throats and other associated symptoms. It is important therefore that pharmacists are aware of these and educated in the key, core messages. Preparing monthly displays about particular subjects, or a dedicated winter health display could be a perfect opportunity to promote self-care for colds, coughs and other winter ailments. Look out for printed leaflets and booklets that can be displayed on a healthy living pharmacy display table and handed out to customers or attached to prescription bags.

Engage with those ‘at-risk’ Using Self-Care and targeted campaigns as a tool to drive footfall to the pharmacy also gives you the perfect opportunity to engage with those people who are most at risk of flu. For people aged 65 and over and those with long-term health conditions, including diabetes and kidney disease, flu can be particularly dangerous. If you feel that a customer falls into one of those categories, it might be worth advising them to book in for a flu jab as soon as possible to reduce their risk. Remind them that your pharmacy can offer this service, particularly if they are eligible for a free vaccine. Although the World Health Organisation works to produce timely vaccines based on information available at the time, if the strain of flu mutates it may not be as effective. That’s why it’s also important that you take the time to advise people on how to tell the difference between symptoms of flu and symptoms of a common cold, so that they can treat themselves accordingly with the right OTC medicines if they fall ill.

If someone has a lot of symptoms and asks for advice on what medicines to take, it might be worth recommending an OTC medicine that can treat a number of symptoms e.g. temperature and muscle aches at once. However, it’s important to remind them not to ‘double dose’ on paracetamol or ibuprofen if the flu medication also contains these. Efficient Merchandising The cough and cold season could also provide the perfect opportunity to reorganise fixtures in your pharmacy with a clear merchandising plan featuring beacon brands in both the P and GSL sections.

that staff are trained to provide advice on seasonal ailments and OTC products. Staff should also deliver public health messages by reminding customers to have a flu jab (see Panel) and, for example, when selling cough medicine finding out if the customer is a smoker and whether they would like help to quit. They won’t necessarily think the water tablets they are taking for their blood pressure are important but they could react with the decongestant in a cold remedy and cause problems. This could be a cue for the pharmacist to check through their medication records to ensure they are getting appropriate advice.

You really need to think about the winter season and make a proper planogram, that provides a merchandising tool on a tablet, so that any member of staff can scan the fixture and see what it should look like. Make sure that you feature the national bestsellers, as these beacon brands act as visual clues for customers and direct them to the products they are looking for.

AILMENT OVERVIEW

There needs to be some offers that make the pharmacy look competitive and it is crucial

Symptoms commonly associated with the common cold include coughing, nasal

Common Cold The common cold is a condition that is prevalent in the community and is associated with a variety of symptoms. Typically, it is an acute, self-limiting viral infection of the upper respiratory tract that is most frequently caused by rhinoviruses.

Pharmacy Advice on Flu Vaccine It is important all community pharmacists urge their customers in at-risk groups for the flu to get vaccinated. Those in at-risk groups include people aged 65 and over, pregnant women and people with chronic illness. Healthcare workers should also get the vaccine to protect themselves and those that they care for. Ann Marie Horan, Pharmacist at Fortfield Pharmacy Dublin explained the importance of getting the flu vaccine, “The flu is a highly-infectious and potentially a very serious illness. In recent years, January has been the peak month for flu cases including hospitalisations and unfortunately fatalities as well. The HSE says there has been a significant increase in flu cases reported at hospitals in recent days as schools reopen and people return to work. This year’s flu vaccine is a good match for circulating strains and the vaccine is the best way to protect yourself from getting the flu.”

“While some people may feel that it is ‘too late’ in the flu season to avail of the vaccine, that is certainly not the case. The flu season in the Northern hemisphere typically runs until April, with January and February the most virulent time. For anyone who has not yet done so we would strongly recommend getting the flu vaccine at your earliest convenience, which you can get at your local community pharmacy.” The vaccine is particularly important for those in at-risk groups, Ann Marie Horan advised, “Given the potentially serious complications of flu, anyone aged 65 years and over, pregnant women and those with a chronic illness should urgently avail of the flu vaccine. However, even those outside the at-risk groups should consider getting the vaccine as by protecting themselves they are also protecting those around them.” Ann Marie Horan, Pharmacist, Fortfield Pharmacy Dublin

PHARMACYNEWSIRELAND.COM | 33


pain and fever associated with sore throats and colds. Ibuprofen also reduces inflammation, which can help if sinuses are inflamed. Paracetamol and ibuprofen can be used in conjunction with one another but should be taken two to three hours apart for maximum benefit. Combination products - Can contain ingredients such as a decongestant, analgesic, cough suppressant, antihistamine or an expectorant. These can be used up to their maximum dose for up to seven days unless they contain sedating antihistamines, when they should only be used for up to three days. Antihistamines work by drying up nasal secretions and should be used with a decongestant as they are relatively ineffective on their own. They can also cause drowsiness, so are often found in combination products to aid insomnia associated with having a cold.

congestion, low-grade fever, and fatigue, usually presenting 1 to 2 days after exposure. Generally, most symptoms subside within 7 to 10 days, although some symptoms can persist for up to 3 weeks. The common cold is often mistaken for the flu. The flu is caused by the influenza virus, classified as type A, B, or C. Types A and B affect humans, with type A generating more severe symptoms. The influenza virus can be dangerous in older people and in those patients who are immunocompromised. Nevertheless, people with influenza are sicker than those experiencing common cold symptoms and commonly manifest such signs and symptoms as temperatures greater than 102°F, chills, headaches, myalgia, and malaise. Sore Throat Sore throat is a hallmark symptom of both viral and bacterial infections of the upper respiratory tract. Sore throat is a self-limiting complaint, resolving within three days in 40% of sufferers and within one week in 85% of people - even in those cases with a bacterial aetiology. The key symptom of sore throat is pain at the back of the mouth, which can vary from localised mild discomfort to intense pain on swallowing. For sore throat sufferers

presenting in pharmacy, regular use of paracetamol or ibuprofen-based products can be recommended to relieve pain (soluble analgesics can be gargled to provide targeted pain relief). Customers can also be advised to use simple mouthwashes at frequent intervals (e.g. warm, salty water) until the discomfort and swelling subsides. Sucking pastilles or lozenges stimulates saliva secretion, which lubricates the throat, and many throat sweets also contain soothing ingredients, such as glycerine and honey, to help relieve irritation. Nasal Congestion Nasal congestion is a blocked, stuffy or bunged-up feeling in the nose. Depending on the cause, it can last a short while (a few days) or can be persistent. In adults and children it is usually an annoying symptom rather than a serious one. In babies, however, a blocked-up nose may make it difficult to breathe or feed. Some of the causes of nasal congestion include: • Infections: the common cold and other respiratory tract infections, including influenza (flu) and sinusitis. • Allergies, including hay fever. • Persistent rhinitis.

34 | PHARMACYNEWSIRELAND.COM

Sinusitis The sinuses are small, air-filled spaces inside the cheekbones and forehead which drain into the nose. Sinusitis means inflammation of a sinus. Most bouts of sinusitis are caused by an infection. Most cases of sinusitis are acute (lasting 1-4 weeks) but some may go on to a more persistent (chronic) sinusitis. The symptoms of sinusitis are mainly nasal congestion, and pain in the area of the affected sinus. This is most commonly in the forehead or cheeks on one or both sides of the nose. The pain may be worse on bending down. Other symptoms which may occur are dizziness and fever. Sinusitis is usually treated with painkillers and decongestants. MEDICATION SUMMARY: Decongestants - These help to reduce nasal congestion by constricting the dilated blood vessels in the nasal mucosa. This reduces swelling and oedema of the nasal mucosa, making it easier to breathe. Decongestants are not suitable for pregnant and breast-feeding women and patients with hypertension. Nasal sprays and oral tablets should not be used concurrently. Oral analgesics - Analgesics and antipyretics help to reduce

Inhalants, vapour rubs and saline products - Inhalants work by helping to clear the nasal passages, while steam inhalation will help ease nasal congestion by loosening mucus. Saline preparations relieve congestion by helping to liquefy mucous secretions. Inhalants, rubs and saline products can be used daily until symptoms are cleared. They can be used as an alternative by patients who cannot tolerate decongestants. Sore throat treatments - Most sore throats are caused by a viral rather than a bacterial infection, so don’t need antibiotics. Medicated lozenges or anaesthetic sprays can help relieve the symptoms of sore throat. Gargling regularly with an antibacterial mouthwash or warm, salty water can reduce any swelling and inflammation, while sucking pastilles or lozenges will stimulate saliva secretion to lubricate the throat and help relieve irritation. Cold sore treatments - Cold sores usually clear up without treatment within seven to 10 days but antiviral creams, such as aciclovir or penciclovir, can be used to ease symptoms and speed up the healing time. Antiviral tablets are generally more effective than creams at treating severe cold sores, but are usually only prescribed in more intractable cases. Patches that contain a hydrocolloid gel can be placed over the cold sore to hide the affected area while it heals.


Cold and Flu Film-Coated Tablets contain:

Professionally recommended for: Colds and Flu Runny Nose

Pain Relief Congestion

A triple combination of antihistamine, analgesic and stimulant

Does not contain Pseudoephedrine

Caffeine strengthens the analgesic and antipyretic effects of Paracetamol*

An optional adjuvant therapy for the management of the symptoms of upper respiratory tract infections

Product Code: 5903 Product: Cold and Flu Film-Coated Tablet Unit Barcode: 5013837204072 Size: 20 P PA Holder : Seven Seas Limited, Bedfont Cross, Stanwell Road, Feltham, TW14 8NX, United Kingdom PA 417/18/1 Seven Seas Limited is a member of the Merck Group *Summary of Product Characteristics, Ilvico Cold and Flu-film coated tablets, CRN 2167729: Date Printed December 2015

Further information is available on request from Brandshapers on 053 91 79007 or customerservice@brandshapers.ie


36

News

Star Medical Ireland give Hugh’s House a few helping hands Hugh’s House provides accommodation 365 days a year to the families of children who are longterm in-patients of Temple Street, Holles Street, the Coombe and Rotunda Hospitals in Ireland. This year, 15 people from the Star Medical Ireland team took some time out to support this great charity, which relies completely on the efforts of volunteers to provide their services and funding. Hugh’s House tries to make life a little more manageable and comfortable for the families coping with the stress of having a very sick child. On Friday 17th May 2019, the Star Medical Ireland team spent the day cooking, cleaning, and ironing for current families staying

at the house. They also got down to some gardening, painting and general DIY tasks to help keep the house well-maintained. Approximately 25 people were staying at Hugh’s house on the 17th of May - all after another physically and emotionally tiring day at their child’s bedside, but at least they came home to a nutritious home cooked meal, a clean house, their laundry done and a pleasant homely environment.

Said James Quinn, General Manager Star Medical Ireland, “Hugh’s House is run by a devoted team of caring volunteers and supporters who try to provide families with the practical help they need when their child is seriously ill. They are reliant on help from volunteers. If your team is looking for a charity to support, I’d highly recommend Hugh’s House. Even if all you can give is a day, your team can make a difference to families in their hour of need.”

If you or your team/company would like to make a difference you can donate your time, or you can gift the time of skilled tradesmen to ensure that Hugh’s House accommodation is maintained on a longer term basis. Interested? Please contact Maria from Hugh’s House on 083 3585611 if you’d like to make a difference. Every hour helps!

Nikki stirring things up in the kitchen

James Quinn and team take a break from the gardening

Lesley-Ann loving the ironing

Louise, Belinda, Tanya and Emily preparing loads of delicious veg for the 25 residents’ evening meal

Emily gets the gloves on for a spot of cleaning

The Full Star Medical team after a long, fulfilling day at Hugh’s House

PHARMACYNEWSIRELAND.COM


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38

News Drug Shortages

Pharmacy targets back to school It is estimated that as many as 20,000 under the age of 14 in Ireland could have nits at any one time. As a result, local pharmacy group, CarePlus, has unveiled a new series of supports for families as schools prepare to reopen. Cormac Spooner, Pharmacist, Spooner’s CarePlus Pharmacy, Templelogue

their friends. We’re well used to parents calling in to us with all of these concerns at this time of year, and we’d love to help them avoid some of the issues if possible, through this new Community Chats initiative.” Staff at the more than 60 CarePlus Pharmacy outlets nationwide are preparing to host a series of Community Chats with the local pharmacist their customers know and trust. They will offer expert advice on areas including first aid, the benefits of vitamins for children, building little ones’ immune systems and preventing and managing conditions like head lice, warts, chicken pox and other rashes.

As children begin another academic year, CarePlus Pharmacies are urging parents to put “Nit Watch” at the top of their ‘to do’ list. While it’s hard to identify exactly how many children are infected with head lice, The peak age for infection is 7-8 years. Head lice are small insects about 1-3mm long with moving legs that live in human hair. They cannot

jump, swim or fly but can be commonly passed from child to child when in close proximity to each other in school. Despite a common and unfair perception, their presence does not reflect standards of hygiene. Pharmacist Cormac Spooner from Spooner’s CarePlus Pharmacy in Templeogue, Dublin says, “This is such a busy time for parents and we know from experience that headlice, colds and skin conditions can spread quickly when kids get back together with

Helping customers and patients be proactive about their health and wellbeing is central to the mission of CarePlus Pharmacies. Commercial Director Niamh Lynch says, “Kids might be sad about the end of the holidays but it’s no fun for parents either as they prepare to face the annual concerns surrounding their children’s health. This year, CarePlus wants to reach out and ensure parents have the best advice and information to help Back to School time run as smoothly as possible.”

Interested in helping future pharmacists? The first 5th-year placements of the new integrated pharmacy programme will begin in January 2020. APPEL is now accepting expressions of interest from pharmacists who would like to facilitate an experiential learning placement for a 5th-year pharmacy student.  Placements can be in community or hospital practice settings  Placements will last 8 months from the 6th of January to the 28th of August  Trainers must be 3+ years registered with the PSI  Training and support will be provided to all pharmacists facilitating placements Students will have previously completed a 2-week placement in 2nd year and a 4-month placement in 4th year and are now looking

forward to completing their 8-month 5th-year placement. Pharmacists who have previously taken students in their 2nd and 4th years have found the experience enjoyable and rewarding. In surveys, 90% of pharmacists said they would recommend facilitating a placement to other pharmacists. The advantages of facilitating an APPEL placement include:  Continuing Professional Development – APPEL Trainer Training can contribute to your CPD, as can the experience of facilitating a placement.

PHARMACYNEWSIRELAND.COM

 Development of your talent pipeline – 5th-year students are close to completing their studies and may soon be looking for their first role as a pharmacist.  Engagement – participating in the APPEL programme provides you with the opportunity to increase awareness of your pharmacy/organisation. If you are interested in facilitating future pharmacists’ training, please call 01-4025129, email ops@appel.ie or go to www.appel.ie to find out more.

The Health Products Regulatory Authority has been notified of a shortage of the following products: • Cisplatin 1mg/ml Concentrate for Solution for Infusion (50mg/ml presentation) – PA0822/199/001 • Cisplatin 1mg/ml Concentrate for Solution for Infusion (100mg/ml presentation) – PA0822/199/001 • Efexor XL 37.5mg Prolonged Release Capsules – PA0822/072/001 • Lercanidipine 20mg Tablet – PA0126/187/002 • Megace 160mg Tablet – PA1696/002/001 • Propofol-Lipura 2% 20mg/ml Emulsion for Injection or Infusion – PA736/018/003 • Septrin Adult 80mg/400mg Oral Solution – PA1691/010/004 • Sotoger 80mg Tablet – PA0577/021/001 • Triapin 2.5mg/2.5mg Prolonged Release Tablet – PA0540/082/001 • Triapin 5mg/5mg Prolonged Release Tablet – PA0540/082/002

Flu Vaccine The annual administration of influenza vaccination training programme, which is delivered online through the IIOP, will shortly include training on the administration of the parenteral vaccination to children from 10 years of age. The updated training programme is expected to be available from 1 September 2019. Pharmacists who complete all relevant training programmes may elect to provide this vaccination service to children from 10 years of age. Additionally, the PSI Council approved a new training specification for the administration of influenza vaccination training programme, to commence in advance of the following vaccination season in 2020/2021. This includes training on the administration of the parenteral vaccination to children from 6 months of age. The PSI will issue updated guidance to pharmacists in relation to the delivery of influenza vaccination services to children from 6 months of age, in advance of the 2020/2021 vaccination season. As a result of these changes, pharmacists will be able to offer influenza vaccination services to a wider cohort of patients, including at-risk groups.


IMBRUVICA® (ibrutinib) is now available as One Tablet, Once a Day1 From September 2019 there will be four new formulations available of IMBRUVICA® for patients1 For patients with CLL or WM 3 x 140 mg

capsules a day

For patients with MCL

1 x 420 mg

tablet one a day

4 x 140 mg

1 x 560 mg

capsules a day

tablet one a day

For full dosing information, please see the IMBRUVICA® Summary of Product Characteristics available at www.medicines.ie. Tablets shown not to scale.

• The same IMBRUVICA® efficacy and safety in a more convenient formulation1,2 • IMBRUVICA® tablets are smaller than the existing capsules and film–coated to help patients take their medication1,3 • Different doses are available1 to facilitate dose reductions, if recommended by the IMBRUVICA® Summary of Product Characteristics and prescribed by the treating physician.

1 x 140 mg

1 x 280 mg

1 x 420 mg

1 x 560 mg

Scan here to learn more about IMBRUVICA®, or visit www.janssenmedicalcloud.ie/imbruvica Experience you can rely on

IMBRUVICA® 140 mg Hard Capsules and 140 mg, 280 mg, 420 mg and 560 mg Filmcoated Tablets PRESCRIBING INFORMATION. ACTIVE INGREDIENT: Ibrutinib. Please refer to Summary of Product Characteristics (SmPC) before prescribing. INDICATIONS: As a single agent, for adults with: relapsed or refractory mantle cell lymphoma (MCL). As a single agent or in combination with obinutuzumab for adults with chronic lymphocytic leukaemia (CLL) who are previously untreated. As a single agent or in combination with bendamustine and rituximab (BR) for adults with CLL who have received ≥ one prior therapy. As a single agent for adults with Waldenström’s macroglobulinaemia (WM) who have received ≥ one prior therapy, or first line in patients unsuitable for chemo immunotherapy. In combination with rituximab for adults with WM. DOSAGE & ADMINISTRATION: Adults: Orally, once daily, swallowed whole with water. MCL - 560 mg (1 tablet or 4 capsules). CLL and WM -420 mg (1 tablet or 3 capsules) as single agent or in combination (refer to SmPC). Concomitant strong CYP3A4 inhibitors – reduce dose to 140 mg (or withhold IMBRUVICA for up to 7 days). Concomitant moderate CYP3A4 inhibitors – reduce dose to 280 mg. Withhold IMBRUVICA therapy for any new onset/worsening grade ≥ 3 non-haematological toxicity, grade ≥ 3 neutropenia with infection/fever, or grade 4 haematological toxicities. Re-initiate when toxicities resolved to grade 1 or baseline. If toxicities recur, reduce dose by 140 mg. A second dose reduction of 140 mg may be considered if needed. Discontinue IMBRUVICA if toxicities persist/recur following two dose reductions. Children: Safety/efficacy not established ≤ 18 years old. Elderly: No dose adjustment required. Renal impairment: Mild/moderate - no dose adjustment. Severe – no data; consider benefit/risk and monitor closely. No data with dialysis. Hepatic impairment: Mild (Child-Pugh class A) – 280 mg daily; moderate (Child-Pugh class B) – 140 mg daily; severe (Child-Pugh class C) – not recommended. Monitor for toxicities. Severe cardiac disease: No clinical data. CONTRAINDICATIONS: Hypersensitivity to active substance/excipients. St. John’s Wort preparations. SPECIAL WARNINGS & PRECAUTIONS: Bleeding-related events: minor and major haemorrhagic events reported; caution with anticoagulant therapy – do not use concomitantly with warfarin or other vitamin K antagonists, avoid fish oil and vitamin E preparations. Withhold IMBRUVICA ≥ 3 to 7 days pre/post-surgery. Leukostasis: cases reported; consider temporary withhold of IMBRUVICA; monitor closely, give supportive care. Infections: infections seen, some resulting in hospitalisation and death; monitor for fever, neutropenia and infections and give anti-infective therapy. Consider prophylaxis in increased risk patients. Progressive Multifocal Leukoencephalopathy (PML): including fatal cases, reported with prior or concomitant immunosuppressive therapy; monitor for new/worsening neurological, cognitive or behavioural signs/symptoms; if suspected, suspend treatment until PML excluded; if in doubt refer to neurologist for diagnostic tests. Cytopenias: treatmentemergent grade 3/4 cytopenias reported; monitor complete blood counts monthly. Interstitial Lung Disease (ILD): cases reported; monitor patients for pulmonary IMBRUVICA® is co-developed with Pharmacyclics. Janssen-Cilag International NV is the marketing authorisation holder and Janssen-Cilag International NV is the responsible editor of this document. © Pharmacyclics LLC 2019 | © Janssen Pharmaceutica NV. 2019 September 2019 | CP-105549

symptoms of ILD; interrupt IMBRUVICA and manage ILD if symptoms develop, if symptoms persist, consider risk/benefit of IMBRUVICA treatment and follow dose modification guidelines. Cardiac arrhythmia: atrial fibrillation/flutter and ventricular tachyarrhythmia reported. Atrial fibrillation/flutter reported particularly in patients with cardiac risk factors/hypertension/acute infections/previous history of atrial fibrillation. Periodic clinical monitoring; consider ECG if arrhythmic symptoms or new onset dyspnoea, dizziness or fainting develop; if signs/symptoms of ventricular tachyarrhythmia develop, temporarily discontinue IMBRUVICA and carry out thorough clinical benefit/risk assessment before considering restarting; consider alternative to IMBRUVICA when preexisting atrial fibrillation requiring anticoagulant therapy or high risk of thromboembolic disease; where no suitable alternatives to IMBRUVICA, consider tightly controlled treatment with anticoagulants. Viral reactivation: hepatitis B reactivation reported; establish HBV status before starting treatment; if positive HBV consult specialist physician; if positive hepatitis B serology, consult a liver disease expert before starting treatment and monitor/manage to prevent hepatitis B reactivation. Tumour lysis syndrome: cases reported. Monitor at risk patients closely, take precautions. Nonmelanoma skin cancer: cases reported; monitor patients. Hypertension: Monitor BP regularly, treat as appropriate. Drug-drug interactions: strong/moderate CYP3A4 inhibitors may increase ibrutinib exposure; CYP3A4 inducers may decrease ibrutinib exposure; avoid strong inhibitors, and strong/moderate inducers, of CYP3A4 where possible; if not monitor closely for toxicities/lack of efficacy. SIDE EFFECTS: Very common: Pneumonia, upper respiratory tract infection, skin infection, neutropenia, thrombocytopenia, headache, haemorrhage, bruising, hypertension, diarrhoea, vomiting, stomatitis, nausea, constipation, rash, arthralgia, musculoskeletal pain, pyrexia, oedema peripheral, muscle spasms. Common: Sepsis, urinary tract sinusitis, infection, nonmelanoma skin cancer, basal cell carcinoma, squamous cell carcinoma, febrile neutropenia, leukocytosis, interstitial lung disease, lymphocytosis, tumour lysis syndrome, hyperuricaemia, peripheral neuropathy, dizziness, vision blurred, atrial fibrillation, epistaxis, petechiae, urticaria, erythema, onychoclasis. Other side effects: Hepatitis B reactivation, leukostasis syndrome, hepatic failure, panniculitis, StevensJohnson syndrome, angioedema, ventricular tachyarrhythmia, subdural haematoma. Refer to SmPC for other side effects. PREGNANCY: Women of child-bearing potential must use highly effective contraceptive measures during and for 3 months after stopping treatment; if using hormonal contraceptives, add barrier method. Not to be used during pregnancy. LACTATION: Discontinue breast-feeding during treatment. INTERACTIONS: CYP3A4 inhibitors: Strong: Avoid where possible or reduce IMBRUVICA dose (or withhold for ≤ 7 days) and monitor closely; e.g. ketoconazole, indinavir, nelfinavir, ritonavir, saquinavir, clarithromycin, telithromycin, itraconazole, nefazodone, cobicistat, voriconazole, posaconazole. Moderate: Avoid where possible or reduce IMBRUVICA dose

and monitor closely; e.g. erythromycin, amprenavir, aprepitant, atazanavir, ciprofloxacin, crizotinib, diltiazem, fluconazole, fosamprenavir, imatinib, verapamil, amiodarone, dronedarone. Avoid grapefruit and Seville oranges. Mild: No dose adjustment required; monitor closely. CYP3A4 inducers: Strong/moderate: Avoid or monitor closely for lack of efficacy; e.g. carbamazepine, rifampicin, phenytoin. Mild: may be used; monitor for lack of efficacy. Potential interactions: Oral narrow therapeutic range P gp or breast cancer resistance protein (BCRP) substrates (e.g. digoxin, methotrexate) should be taken ≥ 6 h before/after IMBRUVICA. Ibrutinib may inhibit BCRP in the liver and so increase exposure of drugs undergoing BCRP-mediated hepatic efflux (e.g. rosuvastatin). Ibrutinib may inhibit intestinal CYP3A4 and thus increase exposure of some CYP3A4 substrates sensitive to gut CYP3A metabolism; caution with narrow therapeutic range oral CYP3A4 substrates (e.g. dihydroergotamine, ergotamine, fentanyl, cyclosporine, sirolimus, tacrolimus). Ibrutinib is a weak CYP2B6 inducer and may affect expression of other enzymes and transporters regulated via the constitutive androstane receptor (CAR) (e.g. CYP2C9, CYP2C19, UGT1A1, MRP2). Exposure to substrates of CYP2B6 (e.g. efavirenz, bupropion) and co-regulated enzymes may be reduced with ibrutinib. Refer to SmPC for full details of interactions. LEGAL CATEGORY: Prescription only medicine. PRESENTATIONS, PACK SIZES, MARKETING AUTHORISATION NUMBER(S): 140 mg bottles, 90 capsules, EU/1/14/945/001; 140 mg bottles, 120 capsules, EU/1/14/945/002; 140mg blister pack, 28 tablets, EU/1/14/945/007; 280mg blister pack, 28 tablets, EU/1/14/945/009; 480 mg blister pack, 28 tablets, EU/1/14/945/011; 520 mg blister pack, 28 tablets, EU/1/14/945/012. MARKETING AUTHORISATION HOLDER: Janssen-Cilag International NV, Turnhoutseweg 30, B-2340 Beerse, Belgium. FURTHER INFORMATION IS AVAILABLE FROM: Janssen Sciences Ireland UC, Barnahely, Ringaskiddy, IRL - Co. Cork, P43 FA46. Prescribing information last revised: August 2019 Adverse events should be reported. Healthcare professionals are asked to report any suspected adverse events via: HPRA Pharmacovigilance, Earlsfort Terrace, IRL Dublin 2, Tel: +353 1 6764971, Fax: +353 1 6762517, Website: www.hpra.ie, E-mail: medsafety@hpra.ie. Adverse events should also be reported to Janssen Sciences Ireland UC on +353 1 800 709 122 or at dsafety@its.jnj.com. References: 1. IMBRUVICA® Summary of Product Characteristics. Available from www. medicines.ie. 2. Janssen Data on File: Imbruvica_DOF_16Jan2019_MI_TN_001. 3. Wright D, et al. How to help if a patient can’t swallow. The Pharmaceutical Journal 2011;286:271-274. For full dosing information please consult the Summary of Product Characteristics, available from www.medicines.ie.


Start with Combodart® (dutasteride/tamsulosin) First line treatment for BPH management for patients with moderate symptoms onwards.1-2 RAPID

SUPERIOR

symptom improvement2

symptom improvement vs tamsulosin from month 91,2

Starts as rapidly as with tamsulosin monotherapy

SUSTAINED symptom improvement over 4 years1,2

3 X LESS AUR AND BPH-RELATED SURGERY* vs tamsulosin at 4 years1,2

Adverse events associated with Combodart include impotence, decreased libido, ejaculation disorders, breast tenderness and enlargement, and dizziness. Men taking Combodart should be regularly evaluated for prostate cancer risk including PSA testing. Any confirmed increase from lowest PSA level while on Combodart may signal the presence of prostate cancer or noncompliance to therapy with Combodart and should be carefully evaluated. For additional/complete safety information, please refer to the prescribing information for Combodart. COMBODART ABRIDGED PRESCRIBING INFORMATION (API). (Please refer to the potentially cause symptomatic hypotension. Intraoperative Floppy Iris Syndrome (IFIS, a variant of small pupil syndrome) has been observed during cataract surgery in some full Summary of Product Characteristics (SmPC) before prescribing)

PRESENTATIONS: Each hard capsule contains 0.5 mg dutasteride and 0.4 mg tamsulosin hydrochloride. INDICATION: Treatment of moderate to severe symptoms of benign prostatic hyperplasia (BPH). Reduction in the risk of acute urinary retention and surgery in patients with moderate to severe symptoms of BPH. POSOLOGY & ADMINISTRATION: Adults (including elderly): The recommended dose is one capsule (0.5 mg/0.4 mg) taken orally approximately 30 minutes after the same meal each day. Capsules should be swallowed whole and not chewed or opened. Contact with the contents of the dutasteride capsule contained within the hard-shell capsule may result in irritation of the oropharyngeal mucosa. Where appropriate, Combodart may be used to substitute concomitant dutasteride and tamsulosin. Direct change from dutasteride or tamsulosin monotherapy to Combodart may be considered. Renal impairment: No adjustment in dosage is anticipated for patients with renal impairment. Hepatic impairment: Caution should be used in patients with mild to moderate hepatic impairment. CONTRAINDICATIONS: Combodart is contraindicated in women, children and adolescents; patients with hypersensitivity to dutasteride, other 5-alpha reductase inhibitors, tamsulosin (including tamsulosin-induced angioedema), soya, peanut or any of the other excipients; patients with a history of orthostatic hypotension or severe hepatic impairment. SPECIAL WARNINGS & PRECAUTIONS: Combodart should be prescribed after careful benefit risk assessment and after consideration of alternative treatment options including monotherapies. In two 4-year clinical studies, the incidence of cardiac failure was higher among subjects taking the combination of dutasteride and an alpha1-adrenoreceptor antagonist, primarily tamsulosin, than it was among subjects not taking the combination. Digital rectal examination, as well as other evaluations for prostate cancer or other conditions which can cause the same symptoms as BPH, must be performed on patients prior to initiating therapy with Combodart and periodically thereafter. Combodart causes a decrease in mean serum PSA levels by approximately 50%, after 6 months of treatment. Patients should have a new baseline established after 6 months of treatment with Combodart and PSA should be monitored regularly thereafter. Any confirmed increase from the lowest PSA levels while on Combodart may signal the presence of prostate cancer (particularly high grade cancer) or noncompliance to therapy with Combodart and should be carefully evaluated, even if those values are still within the normal range for men not taking a 5α-reductase inhibitor (see SPC section 5.1). Results of one clinical study (the REDUCE study) in men at increased risk of prostate cancer revealed a higher incidence of Gleason 8 – 10 prostate cancers in dutasteride treated men compared to placebo. The relationship between dutasteride and high grade prostate cancer is not clear. Men taking Combodart should be regularly evaluated for prostate cancer risk including PSA testing (see SPC section 5.1). The treatment of patients with creatinine clearance of less than 10 ml/min should be approached with caution. As with other alpha1-adrenoreceptor antagonists, a reduction in blood pressure can occur during treatment with tamsulosin, as a result of which, rarely, syncope can occur. Alpha1-adrenoreceptor antagonists and PDE5 inhibitors are both vasodilators that can lower blood pressure. Concomitant use of these two drug classes can

patients on or previously treated with tamsulosin and may lead to increased procedural complications during and after the operation. The initiation of Combodart therapy in patients for whom cataract surgery is scheduled is not recommended. Dutasteride is absorbed through the skin therefore skin contact with leaking capsules should be avoided. Tamsulosin is not recommended in patients taking a strong CYP3A4 inhibitor and should be used with caution in patients taking a strong or moderate CYP2D6 inhibitor, a combination of both CYP3A4 and CYP2D6 inhibitor, or in patients known to be poor metabolisers of CYP2D6. Tamsulosin should be used with caution in patients taking a moderate CYP3A4 inhibitor (e.g. erythromycin) in combination with either strong (e.g. paroxetine) or moderate (e.g. terbinafine) CYP2D6 inhibitors, or in patients known to be poor metabolisers of CYP2D6. Caution should be used in the administration of Combodart to patients with mild to moderate hepatic impairment. Combodart contains the colouring agent Sunset Yellow (E110), which may cause allergic reactions. Breast cancer has been reported in men taking dutasteride. Patients should be instructed to promptly report any changes in their breast tissue. INTERACTIONS: The following reflect information available on the individual components of Combodart. Dutasteride: Long-term combination of dutasteride with drugs that are potent inhibitors of the enzyme CYP3A4 (e.g. ritonavir, indinavir, nefazodone, itraconazole, ketoconazole administered orally) may increase serum concentrations of dutasteride. Tamsulosin: Concomitant administration of tamsulosin with drugs which can reduce blood pressure could lead to enhanced hypotensive effects. Combodart should not be used in combination with other alpha1-adrenoreceptor antagonists. Increased exposure to tamsulosin is expected in CYP2D6 poor metabolisers as compared to extensive metabolisers when co-administered with a strong CYP3A4 inhibitor. When tamsulosin is co-administered with both CYP3A4 and CYP2D6 inhibitors there is potential for significant increase in tamsulosin exposure. Caution should be used when Combodart is used concomitantly with cimetidine or warfarin. Diclofenac may increase the elimination rate of tamsulosin. FERTILITY, PREGNANCY & LACTATION: Fertility: Dutasteride has been reported to affect semen characteristics in healthy men. The possibility of reduced male fertility cannot be excluded. Effects of tamsulosin on sperm counts or sperm function have not been evaluated. Pregnancy: Combodart is contraindicated for use by women. As with all 5 alpha reductase inhibitors, when the patient’s partner is or may potentially be pregnant it is recommended that the patient avoids exposure of his partner to semen by use of a condom. Lactation: Combodart is contraindicated for use by women. It is not known whether dutasteride or tamsulosin are excreted in human milk. ABILITY TO DRIVE & USE MACHINES: No studies on the effects of Combodart on the ability to drive and use machines have been performed. Patients should be informed about the possible occurrence of symptoms related to orthostatic hypotension such as dizziness. UNDESIRABLE EFFECTS: DUTASTERIDE AND TAMSULOSIN CO-ADMINISTRATION: The following adverse events have been reported with an incidence of ≥1% during the four years of treatment in a comparison study of dutasteride 0.5 mg

and tamsulosin 0.4 mg once daily for four years as co-administration or as monotherapy): Impotence, decreased libido, ejaculation disorders (including reduced semen volume), breast disorders, dizziness. Adverse Events identified through post-marketing experience (therefore the true incidence is unknown) with dutasteride monotherapy include allergic reactions, including rash, pruritus, urticaria, localised oedema, and angioedema; depression; alopecia; hypertrichosis; testicular pain and testicular swelling. The following adverse events related to tamsulosin monotherapy have been reported from post marketing data: Intraoperative floppy iris syndrome (IFIS); atrial fibrillation; arrhythmia; tachycardia; dyspnoea, epistaxis, vision blurred, visual impairment, erythema multiforme, dermatitis exfoliative, ejaculation disorders dry mouth. Marketing Authorisation (MA) Holder GlaxoSmithKline (Ireland) Limited,12 Riverwalk, Citywest Business Campus, Dublin 24. MA Nr: PA1077/118/001. Legal category: POM A. Date of preparation of API: January 2018. Code: IE/DUTT/0040/15(2). Further information available on request from GlaxoSmithKline, 12 Riverwalk, Citywest Business Campus, Dublin 24. Tel: 01-4955000.

Adverse events should be reported to the Health Products Regulatory Authority (HPRA) using an Adverse Reaction Report Form obtained either from the HPRA or electronically via the website at www.hpra.ie. Adverse reactions can also be reported to the HPRA by calling (01) 6764971. Adverse events should also be reported to GlaxoSmithKline on 1800 244 255. *Actual Risk Reduction 7.7% (4.2% VS 11.9%) (p<0.001) References: 1. Combodart Summary of Product Characteristics, www.medicines.ie accessed January 2018. 2. Roehrborn CG et al. Eur Urol 2010; 57: 123-131. Date of Preparation: January 2018

IE/DUTT/0006/16(1)


Educational

41

Childhood Vaccinations: Not a Given Childhood vaccination is an interesting topic for discussion for many reasons. It can be a polarising issue and it should not be taken for granted that all parents will responsibly put their child into the recommended immunisation schedule. In this first article of a two-part Educational Series, David Reilly, MPSI, looks at the key issues surrounding childhood vaccinations.

all parents are vaccinating their children as they should.

Measles outbreaks

It is of course a personal choice, but it is obvious that there is either a lack of understanding of the importance of vaccinating a child for the benefit of the entire community or a residual fear of bogus side effects and links to other conditions. As healthcare professionals with an understanding of the theory of vaccination we should all be confident that a vaccination cannot cause autism or asthma. Fortunately, we do not need to rely on just theory. Due to the

We are all very aware of recently reported rises in cases of measles in Europe and Ireland. Twenty-one cases have been reported to the HSE since the beginning of 2019. Seven of these have been confirmed in a laboratory with the remainder under investigation.1 To date none of the confirmed cases appear to have been vaccinated. This shows that we cannot take it as a given that

Measles

Why the resurgence of Measles and Rubella

Author: David Reilly, Supervising Pharmacist with McCauley Chemist Navan Shopping Centre. David worked as a community pharmacist in the UK for seven years before returning to practice in Ireland in 2016

controversial UK study of 1998 by Dr. Andrew Wakefield, which claimed a link between the MMR vaccine and autism, extensive studies have now been carried out to demonstrate the safety of vaccinations. Vaccines do not cause autism, diabetes, multiple sclerosis, allergies, asthma or attention deficit disorder.2 Parent Fears However, we should not be dismissive of parents who are concerned about these erroneous links. When things happen to oneâ&#x20AC;&#x2122;s child at the same time as they are vaccinated it is natural to wrongly presume there is a link. The study was

irresponsibly published and has been even more irresponsibly covered ever since. The obvious bias in the study was that autism usually develops around the time when immunisations are given. Because most children get immunised those who develop autism or asthma for example will most likely have been vaccinated. But many huge studies (e.g. every child born in Denmark from 1991 to 1998 â&#x20AC;&#x201C; or half a million children) have been carried out, and have found absolutely no link between the conditions and the vaccines.2 However obvious the risk/ benefit ratio there are still some members of the population who decide not to have their children vaccinated due to the fear of side effects. I have had many patients who are convinced that the flu vaccine I administered has given them the flu. Any pharmacists involved in providing this service will Iâ&#x20AC;&#x2122;m sure have a similar experience with at least some patients during the flu season.

Figure 1: Visual presentation of Measles3

PHARMACYNEWSIRELAND.COM


42

Educational all reported and suspected cases of measles. To this end if you suspect a case of measles you should refer your patient to their GP. This is also advisable in light of possible complications and the possible need for an antibiotic for secondary bacterial involvement. However, as a viral infection once the rash is present, rest and treatment of the symptoms are the only course of action to take. Patients should be advised that without complications symptoms should disappear within seven to ten days. • Advise use of liquid paracetamol or ibuprofen to relieve fever, aches and pains. • Closing curtains and dimming lights can help ease light sensitivity, which forms part of the illness. • Damp cotton wool or blepharitis eye wipes can be used to clean away any crustiness around the eyes. Use one piece per eye for each wipe and wipe gently from inner to outer lid.

Again, there is no proven link and the chances are that they caught their flu during the height of flu season, unluckily before immunity had reached its full strength, which can take up to fourteen days. Convincing them that it is still a good idea to vaccinate again next year will still prove very difficult. The vaccination schedule in Ireland What are the diseases we vaccinate against and why do we consider it necessary? Taking measles as an example we can see the rationale. • Measles is one of the most contagious viruses known. With 90% of unvaccinated people exposed to measles contracting the disease.2 It is spread through close contact. • Measles is a serious disease, with the risk of some serious complications. If 1000 patients get measles one or two will die, 50 will get an ear infection, 40 will get pneumonia or bronchitis 5 will have a convulsion, 160 will get diarrhoea, and one will develop encephalitis.2

• On the other hand if 1000 people a vaccinated, 100 will have mild discomfort at the site of injection or fever, 50 will get a non-contagious self-limiting rash about 10 days after vaccination, 1 will have a convulsion, 1 in 10 million will develop encephalitis and 1 in 22,000 will develop a temporary blood clotting problem. It is obvious that the risk from having the disease far outweigh the risk from getting the vaccination. Immunisation is a simple, safe and effective way to protect a child against the diseases targeted. The decision of the HSE to recommend vaccination is based on this sound evidence along with the benefit of herd immunity to the Irish population and obvious benefit of reducing pressure on primary care services if these diseases are eradicated. Measles is a hot topic in the media now as cases are on the rise once again. It is important for pharmacists to be able recognise and differentiate the measles rash.

PHARMACYNEWSIRELAND.COM

Symptoms of measles include: • High fever • Cough • Runny nose • Red eyes • Red rash that starts on head and spreads down the body – this normally starts a few days after the onset of the illness. The rash consists of flat red or brown blotches, which can flow into each other. It lasts about 4-7 days. • Vomiting diarrhoea and tummy pain may also happen. As pharmacists we should be vigilant for the signs of measles and report any suspected cases to the Health Protection Surveillance Centre. Contact details can be found easily on the website along with a wealth of information on childhood vaccinations.2 Treatment of Measles How we as pharmacists treat a presentation of measles in the pharmacy is very important. GP’s have a duty to notify the local HSE Public Health Department of

• If a cough is present cough bottles are of little genuine benefit and should not be given to children under six years of age. However, glycerine and honey or some honey and lemon in warm water can comfort the child if they are twelve months or older. • Again, a bowl of warm water to humidify the bedroom at night can ease a child’s night cough. • Fever in young children can rapidly lead to dehydration so parents should be advised to ensure the child drinks as much as possible. Part Two of this Educational Series will appear in our October issue, and will look at the topics of Social Media impact on the HPV vaccine, Herd Immunity, Encouraging Parents, Pharmacy Signposting and Support, Vaccinations Services in the Future References: 1. https://www.hpsc.ie/a-z/vaccinepreventable/measles/news/title18833-en.html 2. www.immunisation.ie 3. https://www.google.com/ search?q=images+of+measles+on+skin&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjlnvKNu6HkAhWFUxUIHdx4CocQ_AUIESgB&biw=1366&bih=657#imgrc=3EVnvSc-hrYbcM:


44

News

Pharmacy guidelines on Anticoagulation Therapy The International Pharmacists for Anticoagulation Care Taskforce has, this month, published new Guidelines to support patients receiving Oral Anticoagulation Therapy. Dr Van Den Bemt, Pharmacist, Senior Researcher and Clinical Pharmacologist, IPACT Board Member

providing expert education made iPACT an ideal organisation to initiate the creation of a new Guideline.

Atrial fibrillation (AF), a heart rhythm disorder where the atria beat irregularly and chaotically decreases the heart's bloodpumping efficiency, is the most common sustained heart rhythm disturbance (arrhythmia). People with AF are three to five times more likely to suffer a devastating, debilitating, disabling and often fatal stroke than people without AF. Consistently, 20-30% of all strokes are AF related. The need to create a new Guideline emerged from two key observations. On the one hand, anticoagulation therapy is consistently among the top five reasons for hospital admission, suggesting management of such therapy is suboptimal. On the other hand, there was a need to complement existing guidelines created by well-recognised societies and associations, such as the European Heart Rhythm Association (EHRA) and the European Society of Cardiology (ESC). Greater multidisciplinary vision needed to be incorporated, focusing on the complete patient journey from initiation of therapy to long term management of anticoagulation. Having experience in developing evidence-based guidance to improve patient care and in

Over 20 experts representing several countries and professions participated in this consensusseeking process. The new Guideline was created through extensive work, including a Delphi exercise comprised of four internet-based rounds with an international expert panel, as well as face-to-face semi-structured group discussions and two broader consultation rounds of international key opinion leaders and international umbrella organisations. iPACT made 18 recommendations in the new Guideline, providing the base for optimization of oral anticoagulation care for patients across different countries and health care systems. The top 5 interprofessional recommendations in the Guideline made to support patients receiving oral anticoagulation therapy were: • INR-monitoring, • Transfer of Care between health care settings, • Adherence to medication, • Patient communication and Engagement and • Medication Reconciliation and medication review. “This Guideline is of paramount importance in providing better care to people living with conditions requiring anticoagulation as part of their journey from initiating anticoagulation to having a long

PHARMACYNEWSIRELAND.COM

term condition,” says the principal investigator leading this work, Dr Van Den Bemt, Pharmacist, Senior Researcher and Clinical Pharmacologist and iPACT Board Member from the Netherlands. “The fact that iPACT made all possible efforts to include input in the development of this Guideline from recipients of anticoagulation therapy recognises the importance of involving end-users from early development phases. My views were always welcomed, which is reflective of the collaborative nature of our work. I am certain that this document will be helpful throughout the world, not only for pharmacists, but also for all healthcare professionals,” says Ms Trudie Lobban, MBE, Founder & CEO, AF Association and Founder & Trustee, Arrhythmia Alliance. “Of course, the Guideline is meaningless if not translated into clinical practice! We know that from our experience with cardiologists and pharmacists”, says Professor A. John Camm, one of the Key Opinion Leaders consulted, having vast experience in guideline development and implementation. “To make implementation possible, we are now developing specific initiatives that are primarily aimed at the recommendations considered to be most relevant by the key stakeholders involved,” says Mr. Sotiris Antoniou, U.K. Consultant Pharmacist and Chair of iPACT and co-author of the guideline. “One example is the Transfer of Care between healthcare settings. This is an area where we are already developing a pilot project, ultimately developing initiatives to improve patient safety.” Translating this Guideline into multiple languages and ensuring that it is available in all 25 countries represented by iPACT is the next important step. The aim is to collaborate with national societies and global organisations that have special interests in specific areas of the Guideline. For example, the European Society for Patient Adherence, Compliance and Persistence (ESPACOMP) with relevance to adherence, the European Society of Clinical Pharmacy (ESCP) with relevance

to medication reconciliation and review, the International Federation of Pharmacists (FIP) who are advocating for expanding the role of pharmacists. The Guideline calls for governments worldwide to focus on specific domains of anticoagulation care that require interprofessional collaboration. Shared information platforms, which patients can easily access, are one of the pre-requisites for implementing some of the recommendations. “This international Guideline is an excellent starting point to help guide practice change in our respective countries! We now need to engage our national pharmacy and healthcare leaders to help with the dissemination and application of the Guideline at the primary points of care. Only then will we unlock the potential positive clinical impact,” says Mr John Papastergiou, iPACT Board Member and Frontline Community Pharmacist, Assistant Professor, Canada. Key takeaways • The new Guideline aims to improve the quality of life for all of those diagnosed with atrial fibrillation • The development of the Guideline was initiated by iPACT, and was the result of multinational and multidisciplinary cooperation • There are 18 recommendations in the Guideline • The top 5 recommendations are: o INR-monitoring o Transfer of care between health care settings o Adherence to medication o Patient communication and engagement o Medication Reconciliation and medication review • Recommendations need to be translated into clinical practice, for which interprofessional collaboration is essential


Multi-symptom relief from: Heartburn/Indigestion

Trapped wind & bloating

NEW

PACK!

What does Rennie Deflatine Do? Rennie Deflatine Quickly relieves the discomfort and embarrassment that is caused by bloatedness, fullness after food and trapped wind.

What does Rennie Deflatine Contain? Rennie Deflatine is a combination of two antacids, calcium carbonate/ magnesium carbonate & simeticone, an antifoaming agent. Simeticone causes gas bubbles to come together to form one mass and disperse, thus liberating any excess wind, bloating.

Fullness after food

How to take Rennie Deflatine: As soon as any discomfort is felt, suck or chew one or two tablets. Maximum dosage 11 tablets in one day. Children and adolescents: Not recommended for use in children and adolescents below age 18.

Rennie Deflatine and it’s role in IBS Treatment1 Rennie Deflatine can provide additional benefits to patients suffering with IBS symptoms such as bloating, excess wind due to its mode of action.

IRELAND’S #1 HEARTBURN AND INDIGESTION TABLET* Sugar free

Suitable for diabetics, coeliacs and vegans

Suitable to be taken in pregnancy2

Available front of counter + TV support

Always read the label During pregnancy and lactation, it has to be taken into account that Rennie Deflatine tablets provide a substantial amount of calcium in addition to dietary calcium intake. For this reason, pregnant women should strictly limit their use of Rennie Deflatine chewable tablets to the maximum recommended daily dose and avoid concomitant, excessive intake of milk and dairy products. This warning is to prevent calcium overload which might result in milk alkali syndrome. References: 1. Ching CK, Lam SK. Antacids. Indications and limitations.Drugs 1994;47:305–17. 3. Tytgat GN, McColl K, Tack J et al. New algorithm for the treatment of gastro-oesophageal reflux disease. AlimentPharmacol Ther 2008;27:249–56. 4. El-Serag H, Becher A, Jones R. Systematic review: persistent reflux symptoms on proton pump inhibitor therapy in primarycare and community studies. Aliment Pharmacol Ther 2010;32:720–37. 2. During pregnancy and lactation, it has to be taken into account that Rennie Deflatine tablets provide a substantial amount of calcium in addition to dietary calcium intake. For this reason, pregnant women should strictly limit their use of Rennie Deflatine to maximum recommended daily dose and avoid concomitant, excessive intake of milk and diary products. This warning is to prevent calcium overload which might result in milk alkali syndrome. **Nielsen - Antacids - Value Sales - MAT June 2019

L.IE.MKT.08.2019.2553


Topic Team Training – Heartburn 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. that can have great impact on the patient's quality of life. Heartburn is a burning feeling in the chest caused by stomach acid travelling upwards towards the throat (acid reflux). The main symptoms of acid reflux are: • heartburn – a burning sensation in the middle of the chest • an unpleasant sour taste in the mouth, caused by stomach acid Some may also have: • a cough or hiccups that keep coming back • a hoarse voice • bad breath • bloating and feeling sick Symptoms will probably be worse after eating, when lying down and when bending over.

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 Heartburn.

Burning Issue Community Pharmacists are likely to see many heartburn patients. Heartburn can be relatively benign or become a frequent problem

The groups at risk include those in poor health, particularly the over 55s who are more likely to be overweight and/or have other medical conditions, and people exposed to stress. Most patients know what causes their heartburn. Citrus juices,

bread, coffee, cucumber, and rich and spicy meals are common triggers. Overindulgence in food and alcohol (especially right before bed), smoking, excess weight, and stress are other common causes. If someone has heartburn incidences more than three times a week they may have a more serious underlying problem such as gastro oesophagael reflux disease (GORD). This condition results in the contents of the stomach to back up, or reflux, into the oesophagus. Pharmacy Advice Pharmacists should ask open-ended questions about concurrent medications and supplements, such as NSAIDs, aspirin, glucosamine, and others, that may list heartburn among their side effects. Sometimes pointed questions about lifestyle can help patients select appropriate lifestyle modifications. Pharmacists should remember that for gastrointestinal reflux, certain symptoms should raise an alarm. If patients report any symptom indicative of one of these, referral to a physician is warranted.

Refer patients to the GP if they:

Key Points:

Actions:

• have been self-treating unsuccessfully continuously for ≥4 weeks

Check your pharmacy team are aware and understand the following key points:

 Include POS with associated condition treatments such as other indigestion

 Some antacids contain sodium, which should be avoided by those on saltrestricted diets

 Ensure efficient sign posting to further help and advice or reputable sources for hheartburn treatment

 Two to three days’ treatment may be needed before the full benefit of proton pump inhibitors is felt

 Ensure there is a discreet area in which staff can assist with advice and product selection

• are ≥45 years old with new or recently changed indigestion symptoms • have unintended weight loss in association with indigestion

Consider:  Am I/my team familiar with the differences between heartburn, GORD, indigestion and other GI disorders to make an educated diagnosis?  Am I/my team aware of the symptoms of heartburn?  Am I/my team aware of contributing causes of heartburn in order to advise sufferers of lifestyle changes?  Do I know what to recommend if a customer returns saying the treatment has not worked?  Am I aware of the drug interactions for OTC heartburn medicines?

46 | PHARMACYNEWSIRELAND.COM

 H2 antagonists can be used as soon as symptoms start and as a preventive measure  Sufferers should see their doctor if no relief is obtained within two weeks of continuous treatment.

 Keep products merchandised together, along with related products to help build sales  Ensure the team are able to communicate lifestyle advice  Train the team to meet all the above considerations


TH

ANNIVERSARY

Encouraging heartburn sufferers to seek advice from their pharmacy to help improve symptoms IRELAND’S and control heartburn

No.1

PHARMACY ONLY

HEARTBURN TREATMENT Without Prescription*

For Continuous 24hr Protection

Nexium Control – Pfizer Consumer Healthcare, Ireland. Suitable for people experiencing heartburn. Nexium Control 20mg gastro resistant Tablets and Capsules. Contains Esomeprazole, for correct use read the leaflet. Full product details available on www.medicines.ie * IMS Data May 2019 MAT Value Sales


Enhance your Sexual Health Offering

W

ith greater access to contraception now open for consultation by the HSE, and the recent news that PrEP is to be made available through community pharmacy in Ireland, it is becoming more apparent that pharmacists have a crucial role to play in the area of Sexual Health.

Community pharmacy has, for many years, been involved in providing support for sexual health, selling products ranging from condoms, lubricants, emergency hormonal contraception (EHC), sanitary goods, pregnancy and ovulation tests, herbal supplements for the menopause, treatments for cystitis and thrush and, recently, Viagra for erectile dysfunction. This range of products and services is not available from any other single provider and so community pharmacy is wellplaced to position itself as a one-stop shop for sexual health. This article takes a closer look at how you can develop your sexual health offering to consumers. Sexual health needs vary according to factors such as age, gender, sexuality and ethnicity. However, there are certain core needs for all, including easily accessing services where confidentiality can be assured and individuals feel that they will be treated with respect and will not be judged. Additionally, people want evidence-based information

and advice so that they can make informed responsible decisions and receive high quality services, treatment and interventions. Barrier Protection Condoms offer the best protection from both an unplanned pregnancy and sexually transmitted infections (STIs). Encouraging use of condoms is of utmost importance and can be promoted by listing their advantages: 1. Many contain lubricant 2. 92-98% effective 3. Prevention of STI’s 4. Only contraception males have control of 5. Females can be prepared and carry them also If a customer knows or suspects that a condom has failed, they can access services at their local pharmacy to find out if this has happened and/or what the consequences may be. These (obviously) include the sale of

48 | PHARMACYNEWSIRELAND.COM

pregnancy tests and similar products. However, customers can also access STI screening and detection services at some Irish pharmacies. Screening for common STIs is offered by companies such as Let’s Get Checked. They provide simple kits that a customer may use themselves to extract and store a sample. The sample is then sent to a reputable laboratory to be tested for a range of STI types that are prominent in Ireland. A customer can request screening for a combination of these in accordance with their preferences. What symptoms they may have will depend on the nature of the infection or genital condition. Many people with STIs don’t notice anything wrong or anything different. For example, half of men infected with chlamydia will have no symptoms and 7 out of 10 women infected with chlamydia will have no symptoms. Some STIs or genital conditions may cause small spots, bumps or

blisters on the skin, anywhere in the genital or anal area. In men, some STIs may cause symptoms such as a discharge from the tip of the penis, pain passing urine, pain or discharge from the back passage, or pain and swelling in the testicles. In women, some STIs may cause symptoms such as bleeding after sex or between periods, change in the normal vaginal discharge, pain passing urine or pain in the abdomen. Some viruses may cause flu-like symptoms, fever, feeling generally unwell, loss of appetite, vomiting or diarrhoea. Many people have no symptoms for many years. Treatment for STIs usually involves antibiotics or antiviral medicines. For some, such as genital warts or public lice, creams and ointments are available OTC. Emergency Contraception Emergency contraception is a safe, effective and responsible method of preventing pregnancy when regular contraception has


failed, no contraception was used, and/or in the case of sexual assault. For those who act quickly, emergency contraception will usually prevent pregnancy.

condoms this year. This allows for expanded access to the groups most at risk, and within the youth sector, including third level facilities.

the issues on increasing access to contraception, and will enable the Working Group make appropriate recommendations to the Minister on policy options.

Emergency contraception will not prevent someone from getting a sexually transmitted infection (STI).

“The Working Group has been underway in my Department since April and has done significant preparatory work.

The public consultation will inform the final report to the Minister. It is available on the Department of Health website.

“However, it is important we hear from the public and stakeholders and allow them to have their say on this issue. I would encourage all those with an interest to engage with the Department's consultation before it concludes. It is our ambition to have the Working Group's report concluded by September.”

It is expected that the Working Group will report to the Minister by end September 2019.

The main brand of the ulipristal ECP in Ireland is ellaOne. This pill is available from pharmacies without a prescription. It must be taken within 120 hours (5 days) of unprotected sex but is most effective the sooner it is taken. The IPU protocol supports the ulipristal ECP (ellaOne) as being more effective than the levonorgestrel ECP. Increased Access to Contraception The opportunity for increased access to contraception was, last month, launched to public consultation by Minister for Health Simon Harris TD. Earlier this year, Minister Harris established a Working Group to consider the policy, regulatory and legislative issues relating to enhanced access to contraception, following the recommendation of the Joint Committee on the Eighth Amendment.

In December 2018 the Sexual Health and Crisis Pregnancy Programme (SHCPP) of the Irish Health Service (HSE), launched a national campaign in partnership with the Irish Pharmacy Union (IPU), with the aim to increase public awareness that EC is available to women directly from a pharmacist up to five days (and not only ‘the morning after’) following unprotected sex.

“Removing barriers to contraception in a key priority for me as Minister for Health,” said the Minister.

Women with medical cards can get the EHC pill free-of-charge directly from a pharmacist without the need for a prescription from their GP. This is an important public health measure and will remove any barrier to women getting timely treatment from their local pharmacy.

“We have begun that work through the expansion of free access to

All responses will inform the Working Group's examination of

PrEP introduced in Community Just last month (June), the Minister for Health Simon Harris and Minister for Health Promotion Catherine Byrne committed to implementing a PrEP HIV prevention programme in Ireland, following the formal advice from the Health Information and Quality Authority (HIQA) that such a programme would be safe, effective and cost saving. A PrEP programme involves the pre-emptive use of antiretroviral medication to prevent HIV infection, within a holistic service which includes regular monitoring and testing, as well as advice and counselling on safer sex practices. Similar programmes have recently been introduced in a number of other countries. The health technology assessment (HTA) report from HIQA found that PrEP is safe and highly effective at preventing HIV in people at substantial risk, and also finds that the introduction of a PrEP programme would be cost-saving.

Role of the Pharmacist Pharmacists can use visual tools to communicate to customers about the contraception options available. Leaflets or cards could be supplied to patients receiving their regular contraceptive medication or if supplying emergency hormonal contraception. Leaflets about STI prevention methods and sexual health can be positioned at the counter, or information on posters around the pharmacy. Information slips about safe sex could be included in prescription bags, particularly when issuing scripts for contraceptives and STI treatments. It’s important to remember that its best not to assume anything about the patient when they approach the pharmacy for advice on sexual health. A person who is asking for information may not be sexually active and just want to be better informed. A person may not already know all the facts. Being prepared to go back to basics and giving information in stages ensures you give a patient time to ask questions about what you have said and clarify any areas of misunderstanding. It can be hard to reduce a whole conversation about sexual health into a 30-second-over-the-counter chat. It is much more beneficial if consultations can take place in an appropriately confidential space if possible. This helps to build up a trusting relationship with the patient as confidentiality is a priority when accessing sexual health services in any setting.

Promoting safer sex in Pharmacy CarePlus Pharmacy has announced that it will pay the VAT on condoms at each of its 60 outlets across Ireland on its customers' behalf. The announcement is timed to promote a culture of safe sex as colleges and universities return after the summer break. Figures from the Health Protection Surveillance Centre show a significant increase in the number of sexually transmitted infections amongst young people aged 1524. The HPSC found that nearly half of all chlamydia, one third of gonorrhoea and 39% of herpes cases were diagnosed amongst young people in 2018. CarePlus Pharmacy argues that condoms should be viewed as an essential everyday item, and not subject to the current rate of VAT at 13.5%. There remains concern that cost may be a factor in people making choices around their sexual health. CarePlus Pharmacy has committed to paying the VAT on condoms on behalf of customers until at least October 8th, when details of next year’s budget are announced. Niamh Lynch, Commercial Director of CarePlus Pharmacy says, “We

do not believe that something that helps prevent the spread of infection should be subject to VAT, and that price should not be a barrier to protection. There have been reports that Minister Simon Harris is in favour of a 0% rate on condoms, and we hope that is something the Government will give real consideration to in next year’s budget. Until then, we have committed to reducing the cost of condoms across our pharmacy network to show how much of an impact such a measure can have.” CarePlus Pharmacy has also announced that it is to donate 5,000 branded condoms to student bodies around Ireland for distribution on college campuses. The company has been campaigning on this issue throughout 2019, having previously distributed 10,000 condoms through its 60-strong nationwide network for Valentine’s Day.

PHARMACYNEWSIRELAND.COM | 49


50

News

Updates in Type 1 Diabetes for Pharmacy Advancements in Type 1 diabetes are continuing to be made. Pharmacists must stay current with these treatments, as they interact frequently with patients. Education on injection techniques, hypoglycemia, and new options can improve patients’ lives and position pharmacists as an integral part of the care team. 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.

develop Type 1 diabetes which up to now was T1D, we have now found a way to delay it. This is an incredible advancement that gets us one step closer to our ultimate goal: a future without T1D.”

In news announced this month, researchers are one step closer to preventing Type 1 diabetes as new findings show that a drug targeting the immune system can delay Type 1 diabetes for an average of two years in children and adults at high risk.

TrialNet (funded by US National Institutes of Health (NIH) and Juvenile Diabetes Research foundation (JDRF), is a clinical trial network that tests innovative clinical studies to find ways to maintain insulin production before and after diagnosis. Their Teplizumab Pathway to Prevention Study identified 21 adults and 55 children (relatives of people with Type 1 diabetes) who had two or more autoantibodies and

Dr Anna Clarke of Diabetes Ireland Research Alliance states, “This is great news as researchers now can accurately predict who will

abnormal blood sugar levels and therefore were thought to have a lifetime risk of developing Type 1 diabetes nearing 100%. These high risk individuals were randomly assigned to either the treatment group, which received a 14-day course of teplizumab, or the control group, which received a placebo and followed Participants. All participants regularly received glucose tolerance tests until the study was completed, or until they developed clinical type 1 diabetes – whichever came first. 72% of people in the control group developed clinical diabetes,

ARE YOU INTERESTED IN OFFERING YOUR PATIENTS VERY AFFORDABLE, RELIABLE DIABETES RISK SCREENING?

It tests the amount of glucose stuck to the haemoglobin in your red blood cells. It can be used to diagnose diabetes. More importantly, it can also detect if you are in the pre-diabetic range, where it easier to act. This test is one of the few certified by the international NGSP accreditation body.

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compared to only 43% of the teplizumab group. The median time for people in the control group to develop clinical diabetes was just over 24 months, while the median time for the treatment group was 48 months. Samples collected during the trial are being studied to help researchers understand why certain people responded to teplizumab better than others. Next, TrialNet researchers hope to conduct additional studies to look for ways to extend the benefits of teplizumab. Currently they are conducting two other trials to see if other immune therapy can delay type 1 diabetes.


,

For further information, please contact our Telesales Team: Eugene Jeanne Marie or Rita on

*

Always read the label. Further information is available from Rowa Pharmaceuticals Ltd., Bantry, Co. Cork, Ireland. Freephone:1800 304 400 E-mail:customerservices@rowa-pharma.ie Fax: 027-50417 Date of preparation: (06-19) CCF: 22235 *Multivitamin/Mineral and Calcium & Vit D3 suitable for vegetarians


52

News

Rowa Reflect on Growth and Success From small beginnings at their base in Bantry, Rowa are now celebrating 60 years of business.

Mrs. Wagner, Managing Director at Rowa Pharmaceuticals Ltd. / Rowex Ltd.

The Whiddy Island disaster, also known as the Betelgeuse incident, occurred on 8 January 1979, when the oil tanker Betelgeuse exploded in Bantry Bay, at the offshore jetty for the oil terminal at Whiddy Island, Ireland. The explosion was attributed to the failure of the ship's structure during an operation to discharge its cargo of oil. The explosion and resulting fire claimed the lives of 50 people and cast a dark shadow over the small town. But Mrs Wagner was not a woman to be put off, and she was determined to make it work. She made it known locally to trade and commerce that she was in Bantry to stay and started travelling across the world, promoting Rowa Pharmaceuticals and its products. Even today, you can go into a pharmacy in Afghanistan and pick up a pack of Rowachol. She established its Irish marketing division, Rowex Ltd, with the aim of providing the Irish market with high quality, branded generic products. When Rolan Wagner arrived into Ireland from Germany, he fell in love with the small town of Bantry, a population at that time of no more than 20,000, just an hour south of Cork with a non-existant export presence.

pharmaceutical companies in Ireland. Employing around 100 people, Rowaâ&#x20AC;&#x2122;s products are exported to over 80 countries world-wide.

His instincts proved successful, as Rowa Pharmaceuticals this year are celebrating 60 years of being in business.

When Roland Wagner passed away some twenty years later, in 1979, his wife Mrs Brigitte Wagner-Halswich took over the reins. The business was struggling, the economy was looking bleak and that year was the same year disaster struck, when an oil tanker split causing great devastation.

The main focus back then was on Rowachol, for hepatobiliary regulation, and Rowatinex, for renal therapy. Rowa Pharmaceuticals is now one of the longest-established

Taking over the Reins

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Today, her achievements represent quite a feat. In 1979, Mrs Wagner was a business woman in her mid-thirties in a foreign country in a very male dominated landscape. At this time there was a lot of economic instability which of course fed into uncertainty in employment and union unrest. Mrs Wagner was able to get great support from the local community ensuring that the doors of Rowa stayed open, people had jobs and the company had the opportunity to grow. Travelling the Globe At that time, Mrs Wagner was in the predicament of waiting for payments to come in, before they could go out but, with stealth and determination, gradually the portfolio and the products started to grow and the company began exporting. In 1993 she formed a joint venture with German twin brothers, Hexal Pharmaceuticals, making a footprint into the generics market and started promoting these generics within the Irish market. Hexa subsequently sold to Sandoz/Novartis. Denis Connolly, one of Rowa Pharmaceuticals Ltd./ Rowex Ltd. longest serving members


53 The accounts team at Rowa Pharmaceuticals Ltd./ Rowex Ltd. From left to right: Jane Lee, Anna Daly, Sheila O’Shea, Michael Lyons (Financial Controller) and Ruth Oliver

portfolio. We are also looking at expanding into the biosimilars market and this is going to be huge for us.” Rowa Today Today in 2019, Mrs Wagner is still the Managing Director of Rowa Pharmaceuticals Ltd. The company now has over 100 employees and last year was awarded the best business in West Cork.

As an entrepreneur, Mrs Wagner is a big believer that she has a social responsibility to give back to the community. A few companies do this by making donations however she believes that while a donation is important, it is vital, to get involved in supporting your local community at a hands on, face to face level. As a result, she got involved in the foundation of the Bantry Hospice Project in 1999 and to this day is an active board member. Working with the Community Over the years, the hospice project has donated equipment to the West Cork Homecare team, the palliative team based in Bantry General Hospital and covering patients throughout the region with their care and service. It has also funded specially designed chairs, which are used by patients in their own homes, and has contributed a substantial sum to assist with the West Cork Home care team social worker services. Rowa Pharmaceuticals covers all administration costs for Bantry Hospice Project. All money raised goes straight to the charity, a huge rarity today. Since its inception, Bantry Hospice Project has raised over ¤1million, which has been utilised in a variety of projects such as training, building two palliative care beds at Bantry General Hospital, purchasing five cars for the palliative care team and most importantly, using this money to help families as part of end of life care.

Mrs Wagner is also a great supporter of Bantry Blues GAA, St. Colums GAA, Bantry Bay Golf Club, Bantry Chamber Music and Bantry Tidy Towns. She has also set up a scholarship fund to the value of ¤3,000 which is presented every year to a student at Colaiste Phobal Bheanntrai. Rowa also presents the Derek McCoy medal every year to a student Doctor in UCC who performs his/her training at Bantry General Hospital. Future is Bright Joe Keane is Head Of Operations at Rowa Pharmaceuticals Ltd/ Rowex Ltd. He reflects that the background to Rowa Pharmaceuticals is inspiring, whilst the future looks equally bright. “The industry has changed greatly over the last 60 years. It has certainly become more regulated and more sophisticated. We have also witnessed a dramatic increase in the number of pharmacies. When I joined with Rowa Pharmaceuticals there were just under 1,000 and we are now looking at over 1,900.

“Today, people are more conscious of their own health and wellbeing. They want and need more information. Generic companies provide patients with better value for money, so we help to create competition.

In 2014, Mrs Wagner was presented the “Melvin Jones Fellowship” Award. This was for dedicated humanitarian services on behalf of the Lions Clubs International foundation.

“For a small company such as we are, this is a huge achievement.

Despite her very busy schedule, Mrs Wagner has been appointed by the Irish government as the honorary counsel General of Ireland. An honorary role where she works very close with the Irish ambassador in Germany in promoting Ireland. She recently at an occasion met the President of Ireland and every St. Patrick’s Day, she organises a major event in Cologne to celebrate St. Patrick’s Day promoting Ireland and Germany.

“We are immensely proud of our OTC products and are very strong within the OTC space. For us, the future will encompass continuing to launch OTC products into our existing portfolio, broadening that

Since 1979, Mrs. Wagner has been the driving force behind Rowa. It is because of her hard work, determination and drive that the company is today celebrating 60 years in business.

“We were especially delighted to have won at the OTC Product & Retail Awards earlier this year with Cetrine Allergy. We have actually won a hat-trick of awards recently; winning Best Small/Medium Enterprise in West Cork and Overall Business in West Cork.

Zoë le Roux (Pharmacovigilance & Regulatory Affairs), Éanna Cahalane (Quality Manager/QP), Michael Lyons (Financial Controller), Brigitte Wagner- Halswick (Managing Director), Joe Keane (Head of Operations), Anne-Marie Moloney (Production and Packing Manager), Sinead McCarthy (Laboratory Manager)

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ROWA PHARMACEUTICALS LTD

1959 - 2019

Celebrating 60 years We would like to take this opportunity to say a special thank you to all our valued customers for their loyalty and ongoing support throughout the years. It has been an incredible journey and we are very proud to be celebrating 60 years in West Cork.

BEST SMALL TO MEDIUM ENTERPRISE

OVERALL WEST CORK BUSINESS OF THE YEAR


Automation

55

Achieving measurable growth in Pharmacy automation The benefits of automation within the community pharmacy setting are becoming more visible. Not just within Ireland, but across Europe, the potential benefits for increasing efficiency and service organisation are clear. For Northern Ireland pharmacist Stephen Burns, adopting a greater breadth of automation within his pharmacy has allowed him and his team to achieve safe and effective business growth whilst offering a better service comparative to a manual dispensing system. We spoke to him to gain a better understanding of how he reached this point. Upon qualifying in 2000, Stephen Burns worked in community pharmacy with Bairds Chemist in Whiteabby and East Belfast. He opted for a year out of community pharmacy to develop as a practice pharmacist before starting work in Ballee Pharmacy when it was opened by Lindsay and Gillian Gracey in May, 2009. Stephen has always believed in nothing less than one hundred percent commitment to patient centred care in the community. Ballee Pharmacy is situated in a residential area where there was a need for a pharmacy to serve the healthcare needs of this community. Ballee pharmacy has always been focused on the needs of the local community and how they can best meet these. This has been achieved through health education and Building the Community Pharmacy partnerships with local groups and agencies to better understand the need on their door step and developing the services to reflect this. Polypharmacy Issues A particular point of interest has been ensuring patients are supported to be as compliant as possible with their medications. Polypharmacy is a big issue, with more co-morbidities and an increasing focus on patients being healthy and supported at home. Stephen firmly believes pharmacy plays a key role in this vital element of healthcare as the community pharmacist is best placed to advise, educate and assist patients with their medication. He is always aware of the needs of the community around him. He explains, “One of the challenges we faced as our business grew was the increasing number of patients requiring medication to be dispensed in

Stephen Burns, pharmacist, Ballee Pharmacy

some sort of a compliance aid, sometimes this was supplied by the patient for refill, but quite often it was a multi-dose tray system. This was to support the patient and more often than not a family member or carer to ensure the patient took the right medication and the right time. As any pharmacist will tell you, the management and delivery of this type of service is very time consuming. Quite often we observed errors even when using the multi-dose trays. We had considered automation of our dispensary as our business grew and we wanted to increase the time our pharmacy staff and pharmacists had to support our patients and service delivery. “We then spent a substantial amount of time researching a variety of different options that would align with our strategic plan for growth and development. The pharmacies were providing a service to our community patients using a resource consuming manual system for medicine dispensing which had reached the maximum level that the pharmacies could achieve without employing further staff and finding more space just to solely look after blister packs administration. “This was very frustrating - as a growing business, and keen to succeed, we needed something much better than what we had,” he adds. Realising the traditional methods for medication dispensing were also not up to the quality that their patients deserved, led the team to research solutions in use in other European countries and eventually

they moved forward with a pouch dispensing system. “It was while looking at where most of our time was being spent and considering automation used in other countries that we came across pouching systems, that not only automated the most time consuming part of our week but also allowed us to provide a superior, safer and in my mind a more flexible and easy to use product to our patients. We discovered a pharmacist working with a supplier in England who had tentatively started using a pouching system supplied by Cretem.

Starting point “We ordered our first automated pouching machine in 2013 – at which time, we were servicing over one hundred customers. Each of our two pharmacy sites were manually producing trays for around 80 patients, this was taking up most of a technicians time and a lot of pharmacist time – they were most definitely at capacity in both Ballymena pharmacies.” How does it work? There are various sizes of Robot options to support an automated medication pouching service –

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Automation Ballee Pharmacy

by our newly christened “Hubert the Robot”. The new technology enabled us to safely and efficiently provide better care and support to our patients and their carers.” The two pharmacies in Ballymena benefited beyond Stephens and his colleagues expectations, and within a matter of two years, they decided to add additional technology to the automationservice by purchasing a Medicine Detection Machine which allowed for quick and accurate verification of every sachet producedby the robot. This facilitated excellent traceability, an automated system to monitor production and quality of all the sachets. The additional technology reduced the pharmacists “checking” time by 65%, thereby ensuring increased efficiency in the overall process and another layer of monitoring accuracy of the medications within the sachets. In 2019 the Ballymena pharmacies now support on average approximately 1400 customers with the medication pouching service. The number of new patients continue to grow each month and the pharmacy teams enjoy working with families and seeing the difference it makes to patients and their families.

they can dispense in canisters of 207, 267 or 405 medicine types depending on the size of the pharmacy so the first step in this adventure is to asses the needs of the pharmacy, and potential for growth. Next steps The team ordered the Cretem 405 canister machine for Ballee Pharmacy. They spent substantial time analysing current patient data and patterns, and looking ahead as they knew this was an area where demand for this service was ever on the increase, working with their provider to complete the range of medications each canister should hold for the robot. There are numerous controls that come with automation and once the canisters are calibrated, no other medication can be dispensed through them, ensuring patient safety is paramount. Callibration is carried out in a controlled environment and can take up to four weeks, so while this process was being completed, Stephen and his team planned the arrival

and installation of their new robot at the pharmacy. Teams from both pharmacies worked together to complete a robust set of controls and parameters including training, workflows, patterns, checks, control areas and inventory management. They also developed a complete marketing plan surrounding the launch and continued growth of the service they could offer. These exercises proved invaluable to the process and helped to educate patients about the incredible benefits that can be achieved using a pouching service. Part of the marketing process was to also brand all the consumables with the name and details of the pharmacy for ease of customer service and re-ordering – a simple step, but one which has proven invaluable for customer endorsement. Stephen adds, “It wasn’t long before this side of our business had doubled in size and within a few months we were supplying over 300 patients with their medication in the sachets prepared

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“Our teams also enjoy working in a multi-disciplinary team environment with our colleagues in hospital and practice pharmacy as well as with carers and all the other stakeholders involved in making sure our patients are supported in a safe and efficient manner,” he says. Stephen and his team are delighted with how automating this process has allowed them to achieve safe and effective business growth while offering a better service and know that this could not have been achieved if they had continued working with a manual dispensing system. The growth levels achieved by Stephen and his colleagues after introducing robotic automation into the pharmacy paid for the robot purchase within three years – an incredible result and statistic. The key pharmacy priority for medication pouch dispensing was safety in the dispensing process and a focus on improving health outcomes for patients in ever more cost-effective ways and to help improve patients’ lives in the community and this objective was achieved.

Benefits “We see huge benefits for patients who avail of the pouching service - tablets can be dispensed in single or multi dose sachets, the sachets are easier to read, with descriptions of medicines on each sachet along with date, day and time for administration, they are easier to carry and easier to take the medicines safely. There is no limit to the number of doses and we have programmed the robot software to ensure there are medication reminders for weekly drugs and medicines such as inhalers. The flexibility in the system allows us to change layouts and details on the pouches to meet the needs of any of our patients. Feedback from Patients and Carers would strongly suggest they prefer the sachets over trays. “The pharmacy consistently receives several referrals and recommendations which came from patients sharing feedback with health care professionals,” he reflects. In terms of benefits for the pharmacy, they are several. A weekly supply of medicine can be packed in under a minute. A patient can leave the pharmacy within 15 minutes with their full medication supply. Automated sachets reduce the risk of medication errors. The service minimises time consuming labour and improves workplace efficiency. It also increases the available time to consult with patients Ninety percent of the Robots workflow is managed by a pharmacy technician and the automation facilitates better workflow process and production capability within the pharmacy. Stephen and his colleagues have pioneered this technology in the UK, having tried and tested the technology at their own pharmacy, and having seen, first hand, the benefits for patients and their business growth. They realised very quickly just how much of a positive impact automation of this process had on their patients and as their colleagues looked on and decided to introduce pouch dispensing to their pharmacies PillPacPlus was born. In 2014 they decided to start working in partnership with other pharmacies across the country to make this product widely available. The PillPacPlus network comprise of over 50 community pharmacists who have embraced the PillPacPlus medicine dispensing system as it improves the quality and safety of care given by staff administering medicines in the care home setting.


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Managing Lower GI Problems in Pharmacy

A

ccording to Euromonitor, Irish consumersâ&#x20AC;&#x2122; diets will continue to contain a high proportion of sugars and refined carbohydrates, despite growing concerns over obesity levels. Consumers are not getting enough fibre in their diets also, due to demand for convenience cooking and fast foods.

Overall growth within the Digestive Remedies market is anticipated to be slower compared to the review period due to significant competition and falling unit prices in response to pressure from generic products. If costs increase for importing products into Ireland after Brexit and prices do go up in certain areas, consumers may seek to trade down to generics. Most of the foods we eat require the action of powerful enzymes to extract vital nutrients, that can then be easily absorbed into the blood stream. Without this breakdown of food, undigested food particles can lead to a variety of digestive discomfort including wind, cramping, bloating, diarrhoea and constipation. The good news is that studies show that by supplementing diet with the right combination of digestive enzymes, consumers can take meaningful steps to improve and maintain their digestive health. Supplementing with metabolic enzymes may provide extra support for cardiovascular and immune systems and consumers healthy muscle, tissue and joint function.

Irritable Bowel Syndrome Irritable bowel syndrome (IBS) is quite common with as many as 1 in 5 people affected. It is twice as common in women as men and happens most often to people in their 20s and 30s. IBS is a disorder of the gut whereby the function of the gut is disturbed. However there are no physical or structural abnormalities. It causes a variety of symptoms, which are discussed in further detail below. It usually first appears in teenagers and young adults. What are the symptoms? Pain and discomfort may occur in different parts of the abdomen. Pain usually comes and goes. The length, severity and timing of each bout of pain can also vary greatly. The pain often eases when passing stools (motions or faeces) or wind. Many people with IBS describe the pain as a spasm or colic. Bloating and swelling of the abdomen may develop from time to time. Sufferers may pass more wind than usual. Other symptoms can sometimes occur and include: nausea (feeling sick), headache,

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belching, poor appetite, tiredness, backache, muscle pains, feeling quickly full after eating, heartburn, and bladder symptoms (an associated irritable bladder). Some people have occasional mild symptoms. Others have unpleasant symptoms for long periods. Many people fall somewhere in between, with flare-ups of symptoms from time to time. Diet Most IBS sufferers believe that certain foods cause or exacerbate their symptoms and thus exclude these foods from their diet. Insufficient evidence exists, however, to support exclusion diets or food allergy testing once lactose intolerance and celiac sprue are excluded. Alternatively, some may find it helpful to keep a food diary to determine if gas-producing foods (eg, beans, cabbage, onions, broccoli), carbonated drinks, sorbital, lactose, or wheat aggravate their symptoms and then avoid or limit them to determine if symptoms improve. Pharmacologic treatment is aimed at relieving the predominant GI

symptom, but the goal should be to improve the overall or global symptoms, including altered stool frequency and consistency, abdominal pain and discomfort, bloating, and quality of life. Antispasmodics may provide shortterm relief of abdominal pain and discomfort in IBS, but support for long-term efficacy is not available. Antispasmodics are associated with adverse effects (eg, dry mouth, blurred vision, dizziness, urinary retention), which may limit their use and should be avoided in IBS-C or IBS-M, as they may worsen constipation. Constipation Patients often consult pharmacists for assistance with gastric and digestive complaints, such as diarrhea, gastroesophageal reflux, and bloating. One of the most common complaints is constipation. It is critical for the pharmacist to be fully aware of different options for preventing and treating constipation. Laxatives work in different ways, and the effectiveness of each laxative type varies from person to person. In general, bulk-forming


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laxatives, also referred to as fiber supplements, are the gentlest on the body and safest to use long term. Oral laxatives may interfere with they body's absorption of some medications and nutrients. Some laxatives can lead to an electrolyte imbalance, especially after prolonged use. An electrolyte imbalance can cause abnormal heart rhythms, weakness, confusion and seizures. Combination laxatives: Check labels carefully Some products combine different types of laxatives, such as a stimulant and a stool softener. But combination products don't necessarily work more effectively than single-ingredient products. In addition, they may be more likely to cause side effects. There are instances when referral to a GP may be necessary. These include those with a serious underlying medical condition such as diabetes; those with constipation that has lasted longer than 7 days; those that are pregnant or are breastfeeding; those with unexplained weight loss. Risks • Interaction with medications. A patient’s medical history and medications they’re taking may limit their laxative options. Laxatives can interact with some antibiotics, and certain heart and bone medications; • Complicating conditions. Laxative use can be dangerous if constipation is caused by a serious condition, such as appendicitis or a bowel obstruction. Those who frequently use laxatives for weeks or months, can decrease their colon's ability to contract and actually worsen constipation. • Precautions for pregnant women and children. Don't give children under age 6 laxatives without a doctor's recommendation. Diarrhoea Diarrhoea, which is defined as three or more loose watery stools a day, is common and can be classified as acute, persistent, or

chronic. Acute diarrhoea, the most common type, generally lasts 1 to 2 days and resolves on its own. Persistent diarrhoea lasts 2 to 4 weeks, and chronic diarrhoea continues for at least 4 weeks. Diarrhoea in children usually passes within five to seven days, and will usually clear within two weeks. Diarrhoea in adults that lasts for more than a few weeks may be a sign of a more serious condition, such as Crohn's disease. It should always be investigated by a GP. Babies and children who have had six or more episodes of diarrhoea in the last 24 hours, should also see their GP. Diarrhoea usually resolves on its own without treatment. However, it is important to prevent dehydration. Oral rehydration solutions should be used to replenish electrolytes lost through mild to moderate diarrhoea. OTC loperamide may be given to healthy adults with acute watery diarrhoea, but it should be avoided in patients with bloody stools or fever younger than 18 years. Probiotics – What you need to know Many pharmacies stock probiotics on their shelves, but when asked by customers which probiotic to recommend, what evidence and information do pharmacists have about these products, to make an informed recommendation? Probiotics, according to the World Health Organisation, are live microorganisms that when administered in adequate amounts confer a health benefit on the host. Several different strains of probiotics are available, and each has a specific effect on the body. Consumers, who may have learned about probiotics through television advertisements, may not be aware of the various probiotic formulations available as OTC supplements or understand their effects. As health educators, pharmacists play an important role by explaining the benefits of probiotics in appropriate patients and stressing the importance of choosing a supplement that will deliver the correct type and amount of healthy bacteria to the intestine.

Probiotics are regulated as vitamins and food, rather than as medication, so manufacturers can’t put much information on the product label about potential uses. This means that patients will be relying solely on pharmacists for good and accurate information. Research is ongoing to determine if probiotics are beneficial for everybody, but one thing is clear, they may benefit a lot of different patients for a lot of different things. They help with oral health, vaginal health; they can help with digestion, diarrhea, even allergic conditions. Probiotics contain different strains of bacteria, and the benefits from active ingredients may vary among those taking them. The 3 most common probiotics are strains of Lactobacillus [and] Bifidobacterium, which are bacteria, and Saccharomyces boulardii, which is a yeast. Pharmacists can help consumers identify the strain that they are looking for by reading the active ingredients section of the package label. Probiotic products are not necessarily equivalent to one other, even with the same active bacteria or yeast. Pharmacists should also inform patients that probiotics are considered safe and are associated with only a few mild adverse effects, including constipation, flatulence, hiccups, nausea, and rash. Pharmacists should advise those with compromised immune systems to consult with their GP before taking a probiotic supplement. Supplements often come in capsules, chewable gummies, and powder packets. When offering advice on the use of probiotics, it is important to determine the reason for their interest, to understand their treatment goals, and to educate them regarding the unique properties of applicable probiotic strains. Pharmacists should help appropriate patients select a product that contains probiotic bacterial strains that have been shown to be effective in supporting GI function and/or providing other health benefits in a formulation designed to reach the site of action.

Table One: Factors to consider when selecting a Probiotic Resists the harsh upper gastrointestinal tract conditions Adheres to human intestinal cells Colonises the human intestinal tract Inhibits illness-causing bacteria Balances immune responses Is clinically supported and safe

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Public perceptions of Gut Health Almost three-quarters (74%) of Irish adults have suffered from stress in the last six months—58% say that they noticed changes in their gut health in that time. The new finding has been revealed in the first edition of the Scope Gut Education Index, which sheds light into people's attitudes towards good digestive health, and its effects on digestive disorders, allergies, UTIs, yeast infections, the immune system, and general children's health. Research from the Index shows that almost half of people (46%) are unsatisfied with their level of knowledge on gut health despite 42% of people claiming that they suffer with digestive issues. The Index also examines the prevalence of digestive issues in Ireland and how people cope with them. 60% of women surveyed have been diagnosed with digestive issues in the past and over half of them have been diagnosed with irritable bowel syndrome (IBS). Out of those who suffered with digestive issues, 66% adopted a new diet; over half of these did this without the recommendation of a healthcare professional. The report also looks at the effects of probiotics on severe headaches and the immune system. For instance, more than 3 in 10 of those surveyed suffer with severe headaches and out of those, 33% take a probiotic to help manage symptoms. 77% of those surveyed believe probiotics helps their immune system. Scope have created the Gut Education Index to provide insights and information on gut health in Ireland for consumers and healthcare practitioners. It is Scope's recommendation that the Department of Health creates and regularly updates a dedicated information portal on gut health, IBS, digestive health issues, and health conditions that can be helped as a result of good digestive health. "With such key insight into the nation's current understanding of gut health and its knowledge gaps, we now know that people are unsatisfied with their current level of understanding of gut health and access to reliable sources of information. We must ensure that this changes."


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Irish Pharmacy Awards 2019

Winner

Defining Excellence in Pharmacy Jonathon Morrissey, Community Pharmacist of Marron’s Pharmacy in Clane, was recognised with the prestigious MediMarshal Community Pharmacist of the Year Award 2019. The MediMarshal Community Pharmacist of the Year accolade recognises Jonathon as a pharmacy professional who is defining the future standard of pharmacy through his excellence in practice. Through consistently engaging with his local community via various healthcare and wellbeing initiatives, whilst actively promoting the profession as a whole, Jonathon displays the attributes which best describes those thinking with innovation and leading from the front. Pharmacy Triage Not just in Ireland, but globally, the demands on emergency and primary health care services are increasing. General practitioners and accident and emergency departments are often used unnecessarily for the treatment of minor ailments. The potential for community pharmacists to act as providers of triage services has started to be recognised, and community pharmacy triage services are emerging in a number of countries. This is an area which Jonathon is passionate about. He explains, “Over the last 12 months, I have really pushed on the idea of the pharmacy triage service. A service where pharmacists see patients and triage them as to whether they should see their GP as soon as possible or within a few days. Examples of the service in action include urinalysis screening – a patient thinks they have UTI and they provide a urine sample to the pharmacist who checks it for the presence of leukocytes, protein, blood and nitrates. These elements might confirm the possibility of a UTI and the patient can be referred to the GP. Absence of these elements and nothing else unusual about the sample means

Jonathon Morrissey, Supervising Pharmacist, Marron's Pharmacy, Clane, winner of the MediMarshal Community Pharmacist of the Year 2019

the pharmacist can discuss the possibilities with the patient about why they suspected a UTI and a possibility of treating accordingly. “Undertaking urine screening in pharmacies also means that undiagnosed chronic diseases may be picked up. Protein plus or minus blood in isolation in a male sample may point to a prostate or renal problem. Glucose present in a non-diabetic would signify possible diabetes. There are many other permutations from triaging in a pharmacy this way. Do not forget that pharmacies are very accessible on weekends, often late evenings and bank holidays also so this increased access to the public is only beneficial.”

In the last year, Jonathon and his team have undertaken 51 urine screens.

not to see the GP and you can now inform them that their appointment is warranted.”

“Another triage service we offer is ear and throat examination using a tongue depressor and an otoscope/pen torch. If patients present with a sore ear or sore throat, I inspect these looking for anything other than normal. If you have a patient presenting with a sore ear and you see hard wax, you can sell an OTC product to soften and re-inspect in a few days. This would stave off an unnecessary referral to the GP for a simple wax issue. On the other hand, if you inspect an ear and see otitis media or otitis externa, you may have a patient who was trying

Easing Pressure Jonathon is keen to emphasise that he does not believe pharmacists should, or can, act as a go-around for GPs, but as they too are facing huge pressure on their time and resources, it is vital that patients have another accessible healthcare professional who can help them decide what the best course of action is. “GPs are often pressured to prescribe antibiotics by worried parents and in many instances, they prescribe a delayed antibiotic.


Medi Marshal Pharmacist of the Year Jonathon Morrissey, Pharmacist & Owner, Marrons Pharmacy, Clane, winner of the MediMarshal Community Pharmacist of the Year 2019 screening allowed Jonathon to identify an 11 year-old boy with a pulse of 225bpm. He was referred to Crumlin and the patient is now receiving treatment for SVT (supraventricular tachycardia). Overcoming Challenges Whilst Jonathon is achingly passionate about his profession, and excited for the future, he believes much needs to be done to ease pressure on pharmacists. “Like any other pharmacy, we are threatened by the constant downward pressure on drug prices and the threat of a fees review by the HSE at an all-pharmacy level,” he reflects. “My services have added strings to our bow which are outside the remit of the HSE and PCRS. If and when pharmacy drug prices are amended, usually downward, or if in the future the HSE reduces the fees paid to pharmacies, my services bring in a revenue stream that helps fund the way we operate for our patients.

The worried parent will frequently fill this immediately rather than waiting for resolution. Pharmacists inspecting throats looking for signs and symptoms conducive to an infective tonsillitis or streptococcal throat infection (pus, white spots, fever, etc) can help patients and/or their parents justify the use of the antibiotic at the appropriate time or alternatively, to seek out the GP when that line has been crossed. “This is what I have been doing for the last 12 months with over 350 throats inspected by myself and my colleagues. Any patient now presenting with a sore throat or ear receives an inspection and is treated or referred

accordingly. My one rule is if you are unsure, refer.” Pharmacists and their teams play a pivotal role in integrating healthcare into their communities, and an important aspect of this lies in educating their patients. Putting Marrrons Pharmacy out there as a place where patients can access a higher level of chronic disease information with the option of

“I believe pharmacy needs to evolve. Currently there is too much legislative, bureaucratic and regulatory burden and these combined are making pharmacy a less than attractive proposition for those considering entering the profession. “For me it’s very much about choice and access; choice for the patients to visit the healthcare professional they want and access to services. “I love my patients. I always have. They are why I love doing what I do. They are why I teach this to other pharmacists because I think the pharmacy profession is amazing. We do not get enough credit for the unsung work we do and the efforts all pharmacists go to for their patients. “Equally, we are not good at promoting our work. I’m hoping

Healthcare in Ireland is reactive. Our healthcare needs to be more proactive with increased screening and proper utilisation of all health disciplines, including pharmacists” that someone like me might help other pharmacists think a little differently about why they are a pharmacist. Dispensing medicines is important but there is so much more to be done by us all. “Healthcare in Ireland is reactive. People go to their doctor because they have something wrong with them and their GP naturally treats this request. “Our healthcare needs to be more proactive with increased screening and proper utilisation of all health disciplines, including pharmacists. “I myself have hypertension, diagnosed at 28. My GP never took my blood pressure and most people would ignore a 28 year-old. The Irish Heart Foundation every September will get the shocking stories (young people) who have had stroke or heart attack in their 30s or 20s and use them effectively to remind people that not all illnesses are age-related while some are definitely more common with increasing age. “The more HCPs screening for chronic disease, the better equipped we are for early intervention of patients before a life changing adverse event occurs.” “I was honoured to be told I was put forward for the Irish Pharmacy Awards. It is nice to be recognised for your work and interests in pharmacy,” Jonathon told us.


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Irish Pharmacy Awards 2019

Winner

Glenn Defining the Future of Pharmacy Pharmacy warehouse. He would go on to work across all aspects of the business, leading to a role in the dispensary. Upon completion of his degree and considering his next move, he was approached about his interest in studying for the IPU Pharmacy Technician course. “Working full-time in the dispensary during my first year of the technician course, I fell in love with the profession” he says. “It was then that I knew I was serious about a career in Pharmacy but having not sat any science subjects previously the first time around, I knew if I was to pursue this dream, I would need to complete two science subjects in the Leaving Cert. This meant the 5-year integrated course would now become a 6-year commitment for me, but I decided the journey was worth the time and effort.” Understanding the Patient Glenn recognises the important role he currently plays as both, a pharmacy technician and pharmacy student and furthermore, has an excellent understanding of the relationship between healthcare professionals and patients. Pharmacists are the most accessible healthcare professionals and Glenn recognises their potential to improve quality of care and the opportunity to positively effect patient outcomes. Glenn Ryan, Life Pharmacy: Pharmacy Student of the Year 2019

Glenn Ryan, a Pharmacy student at the School of Pharmacy, Trinity College Dublin and with McCabes Pharmacy in Swords Pavillions, was recognised as a rising star of his profession, picking up the Life Pharmacy: Pharmacy Student of the Year Award.

understand their medication. With excellent communication skills, his expanding knowledge, empathy, enthusiasm and caring nature won over the judges.

Described as someone who takes great pride in his role, Glenn treats every patient the same, knowing them all by first name and making sure they

Glenn has worked in McCabes Pharmacy for over ten years and held roles from stockroom assistant, visual merchandiser, photo lab worker, OTC medicines sales advisor and dispensary receptionist to his current role as a proud certified pharmacy technician.

Approaching Pharmacy with Maturity

A graduate with a degree in journalism, digital media and communication, Glenn has always displayed excellent

customer service skills going above and beyond to meet the needs and expectations of his pharmacy customers.

Says McCabes Pharmacy Superintendent Pharmacist Lisa Byrne, “Glenn’s actions illuminate his maturity and judgement and he has the utmost respect for customers, patients and staff alike. He is reliable, flexible, trustworthy and conducts his actions with a high level of integrity.

Glenn is a mature student, now approaching his fourth year of studying Pharmacy at Trinity College Dublin, where he will gain further experience by completing his four-month experiential learning placement with Perrigo. The judges were hugely impressed with his ambitious, hard-working and passionate approach to not only the profession, but the health, care and safety of his patients.

“Glenn displays maturity in the face of adversity; maintaining a calm demeanour throughout stressful situations, seeking collaborative resolution to conflict and always teaches others the importance of considering and understanding the hardships that patients may currently be facing outside of our pharmacy and so, to have empathy, patience and respect for each customer at the most testing of times.

Having completed his Leaving Certificate some ten years ago, Glenn went on to study a degree in journalism and digital media and began part-time work in McCabes

“Glenn’s judgement is guided by a strong moral compass and is enhanced by his compassion, gratitude, positive and realistic optimism.”


Life Pharmacy: Pharmacy Student of the Year Award Glenn Ryan, McCabes Pharmacy Student with Sharen McCabe, Managing Director, McCabes Pharmacy Group

Glenn’s diligence and devotion to his studies was seen when he studied biology and chemistry for the leaving certificate as a mature student while simultaneously completing the final year of the Irish Pharmacy Union’s Pharmacy Technician course, all while remaining committed to his fulltime role in community pharmacy. His passion for community pharmacy and patient safety is demonstrated in his dissertations completed to date: ‘How community pharmacists can contribute to patients with heart failure’ and ‘How community pharmacists can contribute to the World Health Organisation’s Third Patient Safety Global Challenge’. Glenn’s belief in the value of teamwork is seen throughout his work and participation in interprofessional learning and multidisciplinary teams. Giving that Bit Extra Despite juggling a busy academic and work schedule, Glenn still works proactively to use his skills on an extracurricular level that he is passionate about: helping others. Glenn is

Glenn Ryan, Life Pharmacy: Pharmacy Student of the Year 2019 with Gerard Coffey, Chairman of the Life Pharmacy Group

an avid blood and platelet donor who promotes and increases awareness of the work and service of the Irish Blood Transfusion Service, advertises local blood donation clinic days in Swords and encourages others to get involved. As a voluntary member of the Irish Unrelated Bone Marrow Registry, Glenn was identified as a well-matched potential donor to a patient with a blood cancer or disorder whose only treatment option required them to have a bone marrow (stem cell) transplant. Glenn recently completed a peripheral blood stem cell donation for this patient attesting to his goodwill, selfless and caring nature.

Passion for Pharmacy Despite having graduated in journalism, Glenn’s true passion is pharmacy. But he also recognises it is not without its own challenges. “The role of pharmacy is ever expanding,” he notes. ““I am an advocate of realising the potential of pharmacists; evolving the role and advancing the profession and the services we can provide to the public. We want to offer more, to be more and to do more but with finite resources and tightened reimbursements, this may be difficult. Medicines shortages plus the uncertainty of Brexit are further obstacles to overcome in the care of our patients. We must also embrace the digital age and manage smooth transitions with processes such as the Falsified Medicines Directive implementation and the increasing use of the High Tech Hub Ordering and Management System. Amongst all the changes and developments – one

thing must remain though, that is our duty of care and ensuring patient safety and we cannot lose sight of that priority.” Lisa adds, “Glenn takes pride in his role, he treats every patient the same, knowing them all by first name and making sure they understand their medication. We have a very complex dispensary and we get a lot of queries where we would have to consult with hospitals and Doctors, Glenn takes his time and is meticulous in every query. Glenn’s communication skills are excellent and many a Monday morning have been spent reading his notes in the diary from queries over the weekend. “Many pharmacy students have worked in this store over the years and Glenn is by far and above one of the most knowledgeable, empathetic, caring and enthusiastic students that I have worked with. He will make an excellent pharmacist once he is qualified and will be an asset to any team he works with. “We in Pavilions have been blessed to work alongside Glenn during his journey to date.”


Irish Pharmacy Awards 2019

Winner

Putting customers first & colleagues at the heart of everything we do

Avril Farrell, OTC Medicines Buying Manager, Conor O’ Farrell, Positive Health Buying Manager, Taso Mihalakis, Boots Store Manager and Aine Costelloe, Boots Pharmacist

Believing in putting customers first, Boots Pharmacy Ireland won RB Rapid Relief OTC Retailer of the Year Award for 2019. The Boots team believe in “customers first and colleagues

at the heart of what we do” as a vision for how they want to do things. This strapline helps steer all endeavours through the lens of the customer, ensuring colleagues are supported to have great conversations in store. Customers choose to shop at Boots for their healthcare needs based on quality interactions, led by care, breadth of range and compelling campaigns. Every interaction is important to the team, colleagues feel valued for

the care they provide and are supported and encouraged to provide customers with the best experience. Overcoming Challenges OTC Medicines Buying Manager Avril Farrell tells us, “Having reflected on the past twelve months within the business, the Boots Ireland healthcare team, whilst successfully driving growth during the financial year, were not without challenge. April 2018 brought with

it, legislation governed by the Pharmaceutical Society of Ireland, which led to the re-siting of OTC products to behind the pharmacy counter, products well known to our customers and perceived as a readily available self-select item on the shop floor. “In addition, Ireland experienced the warmest winter on record which hindered opportunity to grow key categories, such as; Immunity, Cough/ Cold and Children’s medicine, all of


RB Rapid Relief OTC Retailer of the Year Award 2019 Conor O' Farrell, Positive Health Buying Manager & Avril Farrell, OTC Medicines Buying Manager, Boots Ireland.

which saw immense growth during the previous year with the prevalence of “Aussie FLU” and an unprecedented rise in incidents. Patient care & healthcare category leaders are the main objectives for the Boots trading team, working to support the overall Irish business. As a small, yet efficient team, they pride themselves on integrity in all of their endeavours. “Our category strategies are underpinned by quality assurance, innovation and breadth of range,” Avril adds. “By delivering the fundamentals, we better afford ourselves opportunities to drive an enhanced customer experience through investment in our stores, local marketing, colleagues and customer reward- all of which serve as strong motivators for us as a team aspiring to lead the market.” Driving the healthcare Agenda

Bernadette Lavery, Managing Director, Pamela White, Category Assistant, Conor O’Farrell, Positive Health Buying Manager, Nathalie Kalo, Assistant Buying Manager, Avril Farrell, OTC Medicines Buying Manager, all Boots Ireland with Michael Graham, Sales Director, RB Health Ireland

Conor O’Farrell, Positive Health Buying Manager with Boots Ireland says, “Customers choose Boots for Healthcare because of the focus we put on ensuring our interactions are led by care, informative and provide a solution which reduces or removes the root cause of the issue. “Patient & colleague care is at the heart of everything we do. Working closely with our suppliers on a local level has greatly increased the opportunity to tailor-make campaigns our colleagues can really get behind and of which our customers ultimately reap the benefits in local stores.

“Through our Boots Advantage Card, we are uniquely placed to offer customers personalised offers and communication, specific to their needs.” On winning the award, Avril says; “As a healthcare led business, winning this award is a fantastic acknowledgement of the hard work and dedication shown by the entire healthcare team at Boots Ireland. The achievement itself serves as a great source of motivation as we continue to strive towards delivering and sustaining a market leading and compelling healthcare proposition for our customers. We look forward to an exciting year ahead, one of which we expect to be brimming with innovation & inspiration, championing everyone's right to feel good.”


Irish Pharmacy Awards 2019

Winner

A Small Business that thinks Big

David Gilsenan, Pharmacist, Hilton’s Pharmacy and winner of the McLernon Computers eHealth & Innovation Award 2019

Hilton’s Pharmacy in Cornelscourt Dublin were applauded for their work in showcasing innovative digital health solutions, as they picked up the McLernon Computers eHealth & Innovation Award 2019.

and helped patients improve their medication compliance. The app is very user friendly and is used by customers from 18 to over 80 years old.

Hilton’s Pharmacy integrated a self-service mobile app into the pharmacy’s workflow. This has reduced wait times in the pharmacy, made ordering prescriptions more convenient

David Gilsenan is Pharmacist and Owner of the pharmacy. He says, “Hiltons Pharmacy is a small business but it does not mean we have to think small. Mobile technology use has been on the rise for years now. There is an app for everything and we felt we could harness this in a manner that would improve services to our patients.”

Thinking Big

From a patient perspective, having the pharmacy available 24/7 via a

self-service mobile app has been invaluable, he says. “We see people communicating with us from abroad and at all times of day and night.” And there have been lots of examples “There was a husband who forgot to get his wife’s post op medication while at work. He was able to scan the prescription using the app and we had it ready for collection on his way home from work. “We also have a patient who is embarrassed to come into the pharmacy. He submits his orders via the app and we can send

messages to him using the app. He has also sent us questions via the app. No phone call necessary. “Patients often ring to see if we have something in stock and rather than rely on them being able to accurately read a prescriber’s writing, they can send a picture of the prescription, simply, easily and securely, via the app and we can give them correct information and advice saving them and us time and ensuring they get the correct medicine quickly and efficiently. “We can also send messages back to the patient via the app about their prescription with regards to stock availability or just a simple message to say it is ready for collection.”


McLernon Computers eHealth & Innovation Award 2019 David Gilsenan, Pharmacist, Hilton’s Pharmacy demonstrates their pharmacy app “The long-term success of pharmacy depends on attracting newer and younger customers. Younger customers (<30) are just used to clicking on an app for everything. Even phone calls are becoming a thing of the past. Everything is becoming on demand.” That is where a mobile initiative comes in. “Our future customers have expectations on how to engage with a business. And a mobile app is part of their expected experience.Ultimately, consumers will drive the adoption of a mobile initiative. Patient Access and Use More generally, the app just makes is easy for patients to submit a prescription and stay on top of their medications. They also get an automatic reminder to order the repeat prescription and by and large they follow through with the order. The medication reminder feature is an excellent compliance aid. The patient can set multiple reminders and can specify what to take on each time. Reminders can be set to weekly or monthly intervals for medicines that are taken on these sorts of intervals. “We have received very positive feedback from parents who are letting their teenage children use it to help them take ownership of their treatments such as acne medication which has, anecdotally, significantly improved medication adherence.” The team set out a number of objectives for their mobile initiative.

 To increase the accessibility of their pharmacies by providing 24/7 access to prescription orders;  Targeting to improve patients’ medication adherence by eliminating ordering bottlenecks and reduce queue times;  A desire to smooth out the busy peaks by getting ahead of patients’ orders and get them prepared in advance.

“This would require investment but with the increase in customer retention and improved medication adherence of patients using our app, it more than pays for itself. “The app has been very successful. It has been widely utilised by our patients improving their medication management, medication adherence and communication with us.

“It has helped younger patients take ownership of their treatments both with regards to taking their medication correctly and ordering their repeat prescriptions. Their parents are still coming in to collect and pay for them! “The medication reminder facility is completely individualised for each patient. It can manage complex dosing regimens. Specific doses can be put in for specific days of the week. A patient could have for example Methotrexate on a Monday, Folic acid on a Tuesday, Humira every second week on a Friday, have to change a patch every Monday and Thursday and then have multiple daily medicines at specific times of the day each day. A notification can come on your phone for each medicine at each specified time on specified days that can say exactly what you want it to say to detail such as ‘remove Transiderm patch’ which could come on every evening at 10pm. It really is quite brilliant.” Any pharmacists wishing to develop their own App can contact David via email on: hiltonspharmacy@gmail.com or by contacting him at: 353 1 289 8889.

“We also wanted to provide a medication reminder service. The app was the perfect platform for this. Ireland Roll-Out “I think as an industry, we have to look at where these types of innovations can bring us.

David Gilsenan, Pharmacist, Hilton’s Pharmacy Cornelscourt Dublin with Robin Hanna, Director, McLernon Computers


Irish Pharmacy Awards 2019

Winner

Cormac Combines Care with Passion

Cormac Black, McCabes Pharmacy, Swords with Jason Bradshaw, Corporate Finance Partner, JPA Brenson Lawlor

McCabes Pharmacy’s Cormac Black won the JPA Brenson Lawlor Young Community Pharmacist of the Year Award for 2019, after impressing the judges with his display of ongoing dedication and commitment to the profession. Cormac has been described as a young pharmacist that has brought a wealth of knowledge, enthusiasm and a dedication and commitment to improving both the role of the pharmacist and the services and level of care given in McCabes Pharmacy. He has adapted exceptionally well to a busy

pharmacy that can be a highly pressurised environment at times with its high volume of dispensing and high footfall. Said a colleague, “It is a tribute to Cormac to how much has developed since completing his degree in 2016.” Cormac is just over 19 months qualified as a pharmacist, having achieved his Masters of Pharmacy from Royal College of Surgeons in Ireland. He commutes daily from his hometown of Drogheda to the pharmacy in Swords. Upon completing his internship year, Cormac took up a position as Support Pharmacist in the McCabes Pharmacy Rathbeale branch.

Points of Care The pharmacy itself is a busy, high volume dispensing community pharmacy with a very large, loyal customer base. It is located in a small shopping centre on the outskirts of the town of Swords. Cormac is part of a pharmacy team of eight, which includes a dispensary team of five, two pharmacists and three pharmaceutical technicians. One of the reasons that Cormac expressed an interest in taking on a role with the McCabes Pharmacy Group was due to the fact that they were very pro-active in point-of-care testing. Cormac is passionate about adopting the newest technology in developing the role of

point-of-care testing within the pharmacy. He recognises that pharmacist intervention can positively influence patients to manage their conditions more adequately. “When I started working in the store, I realised that it was not utilising point of care testing to its potential and quickly set about putting actions into place to resolve this,” he explains. Cormac could see from the high volume of elderly patients that the opportunity was there to extend the services that the store offered in regards to both health screening and health promotion events. He got in contact with the dispensary operations manager as he realised that the store did not have the most up to date equipment available.


JPA Brenson Lawlor Young Community Pharmacist of the Year Award 2019 Cormac Black, JPA Brenson Lawlor Young Community Pharmacist of the Year

with Asthma Ireland, which helped patients with their inhaler technique and had a huge uptake. Again, many patients expressed how they benefitted from this.

“Since getting the health screening service up and running I have developed strong relationships with my customers. Both in my daily dealings with them, and following medicine usage reviews, I can ascertain any risk factors or health concerns that could be diagnosed or managed within the pharmacy, or that may need referral. “With the deregulation of certain products of late, e.g. Sumatriptan, Dovonex, it has been an additional priority of mine to help patients comprehensively manage their conditions such as migraine and psoriasis better without the need for referral.” In the dispensary, Cormac has played a key role in implementing improved systems and procedures that enhance the workflow within. This has involved reorganisation of the dispensary, product storage, filing systems for example. Thirst for Knowledge Cormac shows a continuous thirst for knowledge, a knowledge which he passes on to patients if it can help them in anyway. He undertakes a great deal of continuing professional development, through attending lectures by other industry professionals,

by keeping up to date with literature and by requesting training by pharmaceutical representatives on the latest products available. To date this year he completed CPD on: • Parkinson’s Disease – Treatment and Disease Management • Alcohol and Drug Interactions in the Elderly • OTC sale and supply of Sumatriptan • Parenteral Administration of Medicines • CPR training Cormac is always enthusiastic to organise health awareness days within the pharmacy, and in some cases this involves forming partnerships with other industry professionals. A recent example of this would be an Asthma awareness day in partnership

In 2018, the Group ran a “Pharmacist Leadership Development Programme” through CIPD. This course was intended for pharmacists within the Group who displayed leadership potential and showed enthusiasm for development. The majority of pharmacists identified were supervising pharmacists who had either recently started with the company or were new to the role within the company. Cormac however was one of the first names on the list, which was a fantastic recognition of his talents given that at the time he had only recently qualified and started working with the company. Lisa Byrne, Superintendent Pharmacist with McCabes Pharmacy Group says of Cormac, “Cormac is a young pharmacist that has brought a wealth of knowledge, enthusiasm and a dedication and commitment to improving both the role of the pharmacist and the services and level of care giving in our pharmacy. He has adapted exceptionally well to a busy pharmacy that can be a highly pressurised environment at times with its high volume of dispensing and high footfall. “It is a tribute to Cormac to how much has developed since completing his degree in 2016. I hired him for his Internship with the Adrian Dunne Pharmacy group and at the time, Cormac had no experience of working in a pharmacy and little experience of dealing with the public. Since starting with McCabes, Cormac has regularly gone beyond what is expected of him and excelled at customer service. A recent example of

this is when he provided lifeextending CPR to a customer of the supermarket next door. He did so without hesitation, operating in a calm, professional manner. Paramedics attending the scene praised him and the family of the patient have expressed their gratitude for what he did. “Indeed, as there are no doctors’ surgeries nearby, he is seen in the local community as an exceptional healthcare provider and is often called upon to help in medical emergencies nearby, which he always does willingly and professionally. “Within the pharmacy because of his easy-going and affable nature, he helps to create a pleasant and professional working environment. This spreads to his rapport with customers and patients who warm to his kind and caring personality. “On a professional level, Cormac delivers an extremely high level of patient care, works in a systematic and methodical manner. He is highly reliable, responsible and is willing and able to undertake a management role when necessary. “Cormac has exceeded all expectations of a newly qualified pharmacist and is a huge asset both to the pharmacy team, and to the community, which is lucky enough to have him.”

Cormac Black, JPA Brenson Lawlor Young Community Pharmacist of the Year with Sharen McCabe, Managing Director, McCabes Pharmacy Group


Irish Pharmacy Awards 2019

Winner

Audrey is the People’s Choice in Pharmacy path to achieving her degree would be not only long, but expensive it still wasn’t a viable option, and so she set about studying sales & marketing with a view to pursuing a pharmaceutical sales career. “I was trying to divert myself away from being a pharmacist,“ she explains, “but whatever I did or studied wasn’t hitting the mark. I was still excited about being a pharmacist and working full-time in a pharmacy. I had completely fallen in love with the job, with the atmosphere. The more complicated the prescription, the more difficult the customer, the more passionate I was.” Audrey had tremendous support from her peers. “Peggy Conefrey of Conefrey’s Pharmacy in Pearse Street was a huge mentor to me,” she adds. “I worked for the pharmacy as a technician and it was her belief in me that drove me forward. “Robert Falconer, previous owner of Johnston’s Pharmacy in Ranelagh proved to be another source of encouragement. His advice came at a pivotal time for me, when, as someone from Oxford, he suggested I go to the UK to study. So I visited Liverpool, Glasgow and Aberdeen but fell in love with the latter.” Audrey got the Leaving Certificate points needed and set off for Aberdeen for four years of putting herself through college. Audrey Kingston, Pharmacist, Chemco Pharmacy, Portlaoise, winner of the Pharmaton People’s Pharmacist of the Year 2019

Portlaoise Pharmacist Audrey Kingston was named the Sanofi Pharmaton People’s Pharmacist for 2019. The Chemco Pharmacist’s win came about as a result of a concentrated social media campaign across Ireland. Each of the eight finalists within Audrey’s category were nominated for the award by their local community in recognition of their continued excellence of service throughout the years.

Members of the public then had the opportunity to vote for the winner. With a reach of over 500,000, over 10,000 votes were received via social media, email and website voting during the course of the campaign. It was an extremely close race with a mere 22 votes separating Audrey from the runner-up. “This means everything to me, most especially because I was nominated by my customers,” said Audrey on receiving her award. “My main focus is, and always has been, my customers. I make sure I am front of the counter every day and stay there. Connections are key in this industry, it’s vitally important that members of the public feel a connection to their

community pharmacist and I make connections every day, with a wide range of customers. I enjoy being able to help solve problems, and in helping customers with their healthcare needs.”

She spent some time as a pre-registration pharmacist in both retail and hospital, working with Guys St Thomas Hospital in London before returning to Ireland. Twelve years were spent with LloydsPharmacy, a time in Portlaoise Health Centre and with Adrian Dunne Pharmacy Group before she was recruited by Chemco Pharmacy Group in October 2016.

Hitting the Mark

Looking Back and Forward

For Audrey, being a pharmacist was a lifelong ambition, but the road to achieving this was certainly a long one. Having not been able to achieve the points needed on her Leaving Certificate to study pharmacy, she completed the Pharmacy Technician course, qualifying at 19. However, after realising that she wasn’t as ideally equipped as she would like to answer customer queries and carry out the work that was her real passion. Knowing the

Audrey has noticed many changes to the pharmacy and ladscape since she began her journey on the long road to being a pharmacist. Not least of which is the pharmacist-patient relationship. She reflects, “Having a connection with our patients is a key aspect of our profession. It was definitely much more prevalent when I first started out. This really fails pharmacy, because it is one of our most unique points; helping and advising the communities we serve.


Sanofi Pharmaton People’s Pharmacist of the Year 2019

Audrey Kingston, Pharmacist, Chemco Pharmacy, Portlaoise

“It used to be normal to spend time with your customers, talking to them. Now, we almost have to have time booked in to have a conversation with them. There are so many more demands on us now, between paperwork and general bureaucracy that we are in danger of losing our biggest advantage, being a healthcare professional at the heart of the communities we serve.” Reimbursement is another challenge. “In the early days, there was always money in reimbursement from the PCRS (as it was known then). All of our payments are now being chipped away. “There is great advertising urging the public to ‘Talk to their

Pharmacist’ and signposting towards our services, yet they are taking our payments away and making it much harder for us to live up to the expectation. How can they expect us to do more, with less? “The last three years have been especially difficult, it’s all about number crunching whilst we are losing time with our customers.

Tanya O’Toole, Head of Consumer Healthcare Ireland, Sanofi with Audrey Kingston, Pharmacist, Chemco Pharmacist, Portlaoise They should always come first. Now we are heavily reliant on our Technicians. Of course online drug sales and consumers travelling to the rest of Europe to purchase their medicines presents its own challenges for the profession.” People’s Choice On winning her award, Audrey is still basking in the celebrations. “It was a huge honour for me to be nominated by my customers,

and a great acknowledgement that I am doing my job well. To win has been fantastic; months down the line and I am still getting congratulated daily. “I always say that going into work is like going into my haven. I know I am a good pharmacist but being able to see the difference I am making gives me a great sense of achievement. It is humbling to see that my passion comes across to my customers.”


Irish Pharmacy Awards 2019

Winner

Under the Skin of Excellence The Support Office team told IPN, “Selene provides our CarePlus Pharmacy teams with valuable advice on how to deal with and help their customer with challenging skincare conditions facing them every day. Areas covered in training range from anti-ageing to acne to psoriasis, eczema and skin cancer detection/ prevention among others. “Baby skin is also important to this category, with safe product recommendations for parents who have concerns about their children’s skin conditions.” Selene provides coaching on the holistic approach to skincare by addressing all areas of the patient’s health and wellbeing, including their mental health. A source adds, “Each of our CarePlus Pharmacies have a Category Champion, whose responsibility it is to implement the new range changes running events in-store and awareness campaigns in their local communities.

Aisling Smith, Marketing Executive and Una Shiel, Category Manager, CarePlus Pharmacy Group, winners of the AYA Vitamins Category Development Award with David O’Brien, Commercial Director, Uniphar Group

Focusing on a new skincare campaign led CarePlus Pharmacy Group to win the AYA Vitamins Category Development Award 2019. Pharmacies play a key role as a trusted and safe environment for customers to discuss skin issues. CarePlus Pharmacy Group is Ireland’s fastest growing independent retail Pharmacy group with 60 Pharmacies open nationwide. The CarePlus brand is at the heart of the communities that the Pharmacy teams serve and the brand pride themselves on their commitment to deliver expert advice and services for their customers’ health and wellbeing.

The skincare category was the focus of their project. A CarePlus spokesperson told us, “Skincare is often thought of as a category that revolves around beauty in pharmacies, but our primary focus within the skincare category is around advising customers on the best treatment and products for chronic skin conditions as well as generating awareness about UV protection and the risk of skin damage at all times of the year. Our skincare campaign tagline is ’Be SkinCare Aware’. “We launched our Be SkinCare Aware campaign to highlight the importance and ease of protecting our skin. Throughout the campaign, we will be educating the communities we serve on how to be UV aware and how to use the Irish Cancer Society’s SunSmart Code in their day to day life. “We are continually updating our categories and staying in tune with the market with the help of our experienced team of buyers and

category specialists who ensure that our CarePlus Pharmacies have all the tools and information required to execute the campaign in store. All of our category plans are specific to each of our pharmacies and are ready and available to download from our customer intranet as required.” CarePlus Training Academy The CarePlus Training Academy has been developed to complement the Pharmacy teams’ regular offsite training workshops by providing educational tutorial videos online for their Pharmacists and staff to support their learning. This training system assigns activities based on conditionrelated topics to assist in upskilling and educating their teams. The skincare ambassador for this campaign is Selene Daly a qualified Dermatology Nurse Specialist. Selene is working with the CarePlus Pharmacy group and training the Pharmacy teams through online video tutorials.

“The process of execution is monitored by our team of merchandisers who visit our Pharmacies monthly and our Business Development Manager who completes store visit reports and measures the compliance of the project. “We also bring our CarePlus Pharmacists together every 3 months to discuss changes in the business and have training sessions with them and their front of store teams to discuss the category, implementation of the category and initiatives to support same.” The CarePlus skincare category has grown by 10% since they rolled out additional training in this category in January 2019. Customers’ shopping behaviours have moved very much to e-commerce and self-diagnosing conditions - thus buying products which don’t necessarily work for the condition they suffer from whether it’s acne, psoriasis, eczema, dry skin or sunburn. Specialist skincare advice has most commonly been associated with a trip to the dermatologist and this is an area that CarePlus Pharmacies support in the community.


AYA Vitamins Category Development Award 2019

CarePlus are continually updating their categories and staying in tune with the market with their experienced team of buyers and category specialists ensuring that CarePlus Pharmacies have all the tools and information required to execute in store

Selene Daly, Skincare Ambassador

Community pharmacy is becoming a destination of choice for advice when looking for treatment for many skin conditions. Simple things like explaining the benefits of vitamins, or that Vitamin D is very important for everyone’s health, these are the extra things customers remember the next time they are seeking advice. “Being UV aware is another area customers are not familiar with and it is a focus for CarePlus in 2019 to educate both our younger and older customer base about the effects of UV damage.

Merchandising is very important and CarePlus has a specific approach to the way in which this should be executed. There are pusher systems in all CarePlus Pharmacies so that the staff don’t have to spend time facing off product after a customer purchases from the shelf.

“There is consistent use of our Pharmacy Consultation rooms which makes it much easier for patients to talk about health issues they may feel embarrassed about. Our Skincare Advisors have reported that patients feel more comfortable when they are taken to the Consultation Room.

The category shows the following:

The spokesperson continues, “It is important for us to consider all the elements from regulatory, customer shopping behaviours and supplier influences.

• innovation in range offered • support with Head Office-driven training plan

Measurable Benefits

“Patient care and serving the community is very important to CarePlus and working with experts like Selene Daly (for expert advice and training) and our partnership with the Irish Cancer Society on the Be SkinCare Aware Campaign shows that we are serious about the message we are communicating to our customers and staff.

Compliance is 100% on execution of this category. This is evidenced by the reports from internal store visits.

“CarePlus operate a category management strategy that can leverage our group’s spend and maximise value delivered to our CarePlus Pharmacies through supplier rationalisation, contract

“Our trained skincare advisors are empowered with knowledge of skin conditions to help their customers get results by understanding the condition, how to care for the skin, what treatment options are available and when they should seek further medical advice.”

• effective merchandising - easy to shop • encouragement of incremental purchases • strong promotion offers every cycle

alignment, consistent reporting, robust supplier relationship management, information accessibility and visibility. “This was achieved through exceptional engagement, planning and execution from the CarePlus Support Office and Pharmacies, empowering our teams to become more agile, gaining visibility of data to be better informed and to deliver significant savings. “We regularly carry out research through exit shoppers and mystery shoppers and this research has shown that shoppers form an opinion of a store within the first ten feet of entering. Once customers enter a CarePlus Pharmacy, the initial appearance must make a positive impression and what they see in the first few feet will have a big impact on their decision to return to the Pharmacy or not. “Educating the community on the message of skin protection and being UV aware is a key focus for our Pharmacy teams. As our campaign develops, we will add different elements to support activity and enlist experts to support the initiative.”


78

News

Changes in dysphagia management From September 2019, the descriptions, labels and instructions for the use of modified food and drink products will change as Ireland is adopting the International Dysphagia Diet Standardisation Initiative or IDDSI. This means that Ireland will describe modified food and thickened drinks in the same way as many other countries across the world from the USA and Australia to Sweden. Consistency in how you describe the products makes it safer for the people using them. Community Pharmacists are asked to assist in the process by providing a copy of the patient information leaflet to patients with dysphagia on dispensing their nutritional products such as thickening agents. This change was prompted by the Irish Association of Speech and Language Therapists (IASLT) and the Irish Nutrition and Dietetic Institute (INDI) who recommended that the IDDSI guidelines (2015) replace the current Irish Consistency Descriptors for Modified Fluids and Food (2009). Following a comprehensive review process and engagement with clinicians, this recommendation was agreed by the HSE Leadership Team in November 2018. Dysphagia (difficulty with swallowing) is broadly estimated to affect 4% of the general population. This percentage is much higher among older people and people with conditions such as stroke, Parkinson’s disease, dementia, head and neck cancer. Feeding, eating, drinking and swallowing difficulties are also

prevalent in certain paediatric populations. People with dysphagia can experience difficulty feeding, chewing, swallowing food, drinks or medication and be at risk of choking. Dysphagia can occur at any age and may be short or long term, with the most common causes of dysphagia being related to underlying medical or physical conditions. There are a number of significant potential consequences related to dysphagia including lifethreatening chest infection (or pneumonia), malnutrition, dehydration and reduced healthrelated quality of life. Managing Dysphagia One of the most common ways of managing dysphagia is the use of texture modified foods and thickened liquids. Due to the enormous variation of foods and drinks, and their properties, it is challenging to categorise them to ensure universal understanding of what types of foods and drinks best meet the needs of people with dysphagia. Confusion or miscommunication regarding diet textures and drink consistencies has resulted in increased risk of illness and even death. At the request of Dr Colm Henry, HSE Chief Clinical Officer, the National Health and Social Care Professionals (HSCP) Office established a National Working

Group which coordinated the review and approval of the IDDSI guidelines for the HSE, assessed the impact of transitioning from existing diet descriptors to new ones and developed an implementation plan. The changeover requires careful clinical management, cooperation with product providers, supported by training for staff and information for service users, to ensure risks to people with dysphagia are minimised. The National Working Group is liaising with PCRS regarding changes to labels and mixing guidelines for nutritional products such as thickening agents and nutritional supplements for dysphagia. A national phased changeover to IDDSI begins in September 2019 with a view to having all services transitioned in early 2020. To assist with the implementation of IDDSI guidelines, a suite of resources have been developed by subgroups of the National Working Group to support operational services during the transition including: • Suite of educational resources and recommended training for various staff. • Communication resources. • Patient information leaflet.

Celebrating Milestones One year on since it launched, Irish beauty brand Carter Beauty has looked back on a year full of achievements including new celebrity fans and distribution to new international markets. In February, Grammy award winner Ariana Grande demonstrated the reach of Carter Beauty when she wore the brand’s Supreme Gel Liner in her music video for number one single Break Up WithYour Girlfriend. Her support was followed by that of Kourtney Kardashian, who used its Full Measure HD Foundation in promotional material for popular reality television show Keeping Up With The Kardashians. Most recently, award-winning American music artist Cardi B wore Carter Beauty’s On The Lash false lashes, with her makeup artist also saying that she was “obsessed” with the brand. Pictured (l-r) Marissa Carter founder of Carter Beauty with Claudia Gocoul managing director at the 2019 RDS Christmas Trade Show

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These celebrity endorsements are a fantastic achievement for a brand that prides itself on both quality and affordability, with no product in its range costing more than ¤14.95. With distribution through Uniphar, it has also picked up fans among pharmacy staff and customers alike. To celebrate its first birthday, the brand gave away ¤40,000 worth of free gifts to pharmacy customers in Ireland who bought any Carter Beauty product. In addition to its celebrity endorsements, it has also expanded into new markets and can now be found in the United Kingdom, Spain, Sweden, Canada and Middle East.

Uniphar ¤11m off target Healthcare and drug distribution group Uniphar has said the total proceeds from its initial public offering (IPO) amount to ¤139 million, some ¤11 million off its maximum target, as equity markets succumbed to volatility. The company raised an initial ¤135 million by selling shares at ¤1.15 each before floating in Dublin and London on July 17th. The company also stood to raise a further ¤15 million through the placing of so-called over-allotment shares within 30 days of the deal. However, Uniphar, led by Chief Executive Ger Rabbette, said in a statement that only ¤4.39 million was being raised from the triggering of the over-allotment option. Shares in the company fell by as much as 1.5% during trading in Dublin before rallying 0.4% to ¤1.14 in afternoon trade, leaving it with a market value of ¤311.2 million. Uniphar said it intends to use the proceeds from the placing to complete the acquisition of Durbin as well as bolt-on acquisition opportunities in the near future. The proceeds will also go towards funding additional capital expenditure and working capital for growth of the enlarged group and to reduce group debt. “We have an ambitious strategy for expansion and growth in the coming years and we are now very well placed to progress to the next exciting development phase,” the company's CEO Ger Rabbette said in July. Founded in 1967, Uniphar is the current leader in the Irish pharmaceutical wholesale and distribution market, having built on a number two position achieved by acquiring Cahill May Roberts in 2013 for ¤50m. Uniphar last year acquired 15 pharmacies trading under the Allcare brand, and the healthcare distribution business SISK Group. The Group will announce its interim results for the half year ended 30 June 2019 on Tuesday 17 September 2019.


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80

News

Not too early to think about Movember We may have only just seen the back of the summer, but it’s never too early for community pharmacists to start thinking about Movember. Movember, is an annual event involving the growing of moustaches during the month of November to raise awareness of men's health issues, such as prostate cancer, testicular cancer, and men's suicide. In Ireland, prostate cancer is the second most common cancer in men, after skin cancer. Each year over 3,300 men are diagnosed with prostate cancer here. This means that 1 in 7 men will be diagnosed with prostate cancer during their lifetime. Although there are many men with this disease, most men do not die from it. The Movember Foundation is the leading charity changing the face of men’s health. They say, “We know what works for men, and how to find and fund the most innovative research to have both a global and local impact. We're independent of government funding, so we can challenge the status quo and invest quicker in

what works. In 15 years we’ve funded more than 1,200 men’s health projects around the world. “By 2030 we’ll reduce the number of men dying prematurely by 25%.” Pharmacists across Ireland recently called on all men to use Men’s Health Week (held in June) as the impetus to start addressing their health challenges:

and health services. However, too often, we men put off tackling these issues, and imagine they can wait until we have more time on our hands. Lots of serious health conditions, such as high blood pressure, diabetes and heart disease, can be helped by a healthy lifestyle, and by

Tomás Conefrey, a local community pharmacist and member of the Irish Pharmacy Union (IPU) says, “Men’s health challenges don’t just affect men themselves: they have an impact on families, friendship networks, personal finances, workplaces

reducing alcohol intake and quitting smoking. “Pharmacy staff are well positioned to talk to men about their health needs, explore possible options and, when necessary, suggest that they may need to seek further expert assistance.”

HIQA publishes Corporate Plan The Health Information and Quality Authority (HIQA) has published its Corporate Plan 2019–2021. The Corporate Plan 2019–2021 outlines HIQA’s core values and operating environment and sets out the key objectives it wishes to achieve by 2021. These include safeguarding the vulnerable populations and continuing to carry out health technology assessments. HIQA’s mission is to improve health and social care services for the people of Ireland.

HIQA CEO Phelim Quinn says, “HIQA strives for excellence and continually seeks to improve the quality of the work we do. Over the next three years, we will pursue an ambitious agenda and support the health and social care sector by consolidating our existing functions and assimilating new responsibilities. “During the life of this corporate plan, we will target our resources

to areas of risk and work with others to safeguard people who may be vulnerable. We will continue to conduct independent health technology assessments to support healthcare decision making, and we will develop high-quality standards and guidance for health and social care services. We will also provide advice and thought leadership in defining Ireland’s health information system.

“HIQA does not operate in isolation. To influence the delivery of safer, better services for the Irish public, we will continue to work with others on initiatives such as the National Care Experience Programme and HRBCICER and on the development of standards. We will also establish a citizen forum that enables increased public and service user involvement in our work.”

New appointment at United Drug United Drug would like to announce the appointment of Michael Taylor as Head of Sales and Retail Solutions for the United Drug Wholesale Division. Before joining United Drug, Michael worked with Grupa Santa Rita where he managed a team of export managers looking after the European Business. We would like to wish Michael every success in his new position.

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Recipe Calendar Greenleaf Publications www.greenleaf.ie

Wall Planners

Wirebound Calendars

of Ireland

2020

Greenleaf Publications www.greenleaf.ie

This years recipes are brought to you by Susan Halley and Clare Corballis, who were inspired to create beautiful, nutritional, yet easy dishes, by their student children. They would regularly phone seeking cooking advice and lists of ingredients. In response they got together and designed a set of cards, each with an easy to follow recipe. They now have 3 packs, each consisting of 52 recipes. The packs are entitled “Easy Supper Dishes”, “Lunches, Light Bites & More,” and “Classic Cakes and Desserts.”

Check out their website on: www.getrealrecipes.com

Members

CALENDAR

Your Business

2019

Details are printed here

Details may include Name, aDDress, Logo, Photo, etc. For more information contact Kevin Collins Greenleaf PubliCations Tel.: 086 2533863 Email: info@greenleaf.ie Website: www.greenleaf.ie

Your Business

Details are printed here

Details may include Name, aDDress, Logo, Photo, etc. For more information contact Kevin Collins Greenleaf PubliCations Tel.: 086 2533863 Email: info@greenleaf.ie Website: www.greenleaf.ie We also produce bespoke Calendars a unique Calendar for your business

We also produce bespoke Calendars a unique Calendar for your business

Desk Calendars

2020 Calendar

Magnetic Calendars

Greenleaf Publications Ltd., Newcastle, Clonmel, Co. Tipperary t: 052 6136580 | f: 052 6136397 | m: 086 2533863 | e: info@greenleaf.ie | w: www.greenleaf.ie

HYPERTENSION THE SILENT KILLER

Medicare A4 Blood Pressure Monitor Key Features • Easy to read wide angle display • Compact sleek design • Cuff range 23 - 33cm (9 - 13in) • Irregular heart beat detection • 3 users - 40 memories per user • Automatically averages last 3 measurements • Handy storage pouch Approved by

Order online at www.flemingmedical.ie FREEPHONE 1800 307777

Email pharmacy@flemingmedical.ie

FREEFAX 1800 313395

Free delivery on orders over €100


Register with us today! Med Pharm have exciting job vacancies right across Ireland and are recruiting locum and full-time pharmacists for positions today! Med Pharm is a sister company of Med Doc Healthcare, Ireland’s leading primary care recruitment company specialising in primary care recruitment of GP’s and nurses across Ireland for both the public and private sector. Are you stuck in a rut and looking for a new challenge? We have lots of vacancies from Malin to Mizen Head for both locum and full-time pharmacists. Are you looking for a locum pharmacist to cover your pharmacy during the school mid-terms or over the Christmas period? Are you a pharmacist seeking locum or permanent work in Ireland? Contact Med Pharm today and one of our experienced recruiters will be able to find the best staffing solutions for you whether you are an employer and employee looking for the best jobs available. Tel: +353 1 9011 730 | Email: register@medpharm.ie

Brenson_Lawlor_Selling_Pharmacy_A5_Apr_2019.pdf

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10/04/2019

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Are You Thinking of Selling Your Pharmacy? JPA Brenson Lawlor has over 30 years’ experience advising pharmacy owners and will help you to maximise your return.

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BR Healthcare will manage all sales, marketing & distribution of the Sula sugar free confectionary range from the 1st of July 2019. Alan Finn, Head of BR Healthcare, “We are delighted to be representing the Sula range and believe there is a great opportunity to grow & develop the brand in Ireland. It is an exciting time for the brand with new product developments & consumers making the choice to switch to sugar free confectionary options.”

Contact Us Today for a Free Consultation

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Telephone Jason Bradshaw or Padraic Ferguson on 01-6689760

jason@brensonlawlor.ie padraic@brensonlawlor.ie www.brensonlawlor.ie

82 | PHARMACYNEWSIRELAND.COM

The Sula range are available from BR Healthcare, Blackhall Pharmaceuticals, United Drug & Uniphar. For further information please contact BR Healthcare on 01-885 0800


JOIN OUR TEAM! At McCabes Pharmacy, we have many exciting opportunities to progress and develop your career in pharmacy and pharmacy retail management. We are currently recruiting supervising, support and relief pharmacists in addition to exciting pharmacy retail management opportunities. We can offer you: • A welcoming, friendly and patient focused work environment • Excellent professional support company wide • An opportunity to make direct impact on your dispensary and on patient care • Highly competitive salaries, bonuses and terms • Payment of PSI fees

CURRENT VACANCIES Supervising Pharmacist Ballymun

Pharmacist Manager Bray

Pharmacist Manager Tallaght

• • • •

• • • •

• 40 hours per week • Every second Saturday • One Sunday in every four

4/5 days per week Every second Saturday No late nights No Sundays

45 hours per week Every second Saturday No late nights No Sundays

Also seeking: • Support Pharmacist Dundalk • Relief Pharmacists North and South Dublin • Dundrum Town Centre Assistant Retail Manager

Call our Superintendent Pharmacist, Lisa Byrne. Email: lisa.byrne@mccabespharmacy.com Call: 086 6022844

Deloitte


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IPN 2019 September  

IPN 2019 September