The AJP is reporting from the Blackmores Institute Symposium 2015, which is being held at the Pullman Albert Park in Melbourne.
Pharmacist, life coach and NLP counsellor Vanessa Lontos spoke about tools she has been piloting in two pharmacies in Melbourne, which have seen participating pharmacists report better job satisfaction and ability to connect with patients and engage with them about medicines, quality use of medicines and self care.
Using the PAM score framework, health professionals can identify which of four levels of engagement patients sit in : from not yet believing they have an active/important role in their health care, to beginning to take action and maintaining behaviours over time.
Also the Engagement Behaviour Framework, “a list of 43 behaviours that a patient can conduct to engage in their own health,” is split into 10 groups of behaviours from finding safe decent care to seeking health knowledge.
The subjective experience of health as a driver of health care behaviour is another way of looking at patient engagement, as it recognises the different mental styles for dealing with health and disease.
There are three levels of patient-pharmacist engagement: meeting the immediate need; educating, exploring and empowering; and building and growing (the relationship, and towards better health outcomes).
Naturopath Belinda Wetenhall discussed the prevalence of vitamin and mineral deficiency in Australia in an interactive session where delegates worked on case studies.
“Nutritional deficiencies exist in every modern society and one factor is poor food choice,” she says.
Australians spend three times as much on ice cream as they do health foods, she told the conference; of the top 20 grocery lines 12 are cigarettes and four are different sizes of cola (there’s also coffee, milk and toilet paper in the top 20).
She discussed deficiencies in and supplementation iron, zinc, magnesium, calcium, and vitamins C, B12 and D.
Dr Katherine Gergen Barnett spoke on chronic pain and some of the innovative techniques being used at the Boston Medical Center.
“Chronic pain is one of the most difficult things to treat and to live with,” she told the conference.
She says current treatments are often inadequate and that physicIans frequently under-treat it, because of concern over issues such as addiction and non-compliance. Unlike blood pressure or blood sugar levels, chronic pain is often hard to measure.
She says the Boston Medical Center has piloted group visits for patients living with chronic pain, which include giving the patients a sense of community, information about diet and nutrition, alternatives to medicine such as massage, mindfulness based stress reduction, and online tools such as the Our Whole Lives website. These patients are from a disadvantaged background.
Benefits have included reduced Emergency Department visits, medicines adherence, better health behaviours, improved quality of life and disease-specific outcomes such lower LDL cholesterol or HbA1c.
“We’re not giving pain medication, we’re not necessarily reducing pain, but giving people tools so they can perceive their pain in a different way.”
She adds that in Australia and Boston, many patients have low Vitamin D levels; she frequently prescribes supplementation, as this has in her experienced reduced the pain experience for many of her patients.
Day two: George Tambassis from the Pharmacy Guild has spoken about the 6cpa and pharmacy transformation.
A transformed pharmacy involves leadership and resilience, business management and alignment, technology and IT alignment, the right people in the right jobs with the right skills, innovation, health solution excellence and community engagement.
“Complementary medicines are having a huge increase in sales through pharmacy… There’s a lot of complementary medicines being sold through pharmacy that should play a role in your pharmacy transformation and should play a role in community pharmacy agreement programs and services as well.”
While a general recommendation for omega-3 intake is useful, attention needs to be paid to individual variation in omega-3 levels, says Professor Peter Howe.
“We have to get away from thinking about populations and population requirements, we are individuals,” he told the conference.
The type and amount of omega-3s people require depend on their own individual requirements, though at a population level aiming for 500mg/ day is useful.
Prof Howe says that a person’s omega-3 index can be a predictor of sudden cardiac death, for example; omega-3 levels are also inversely correlated with overweight and obesity. Studies have also shown that people with major depressive disorder are more likely to have low levels.
Professor Andrew Scholey discussed the growing evidence for the use of curcumin – the compound which gives turmeric its bright yellow colour – with regard to its efficacy in cognitive decline.
He highlighted the issue of bioavailability: while there is a correlation between regular consumption of curry and a lower cognitive decline, according to data he cited, curcumin is not well absorbed from the diet and is also rapidly metabolised.
“If you eat a lot of turmeric you don’t really get a lot of curcumin being absorbed into the body,” he says.
However a trial of curcumin supplement showed improved attention and working memory in the very short term, and after four weeks patients were found to have reduced fatigue, particularly physical fatigue; curcumin also produced a resistance to the fatiguing and negative mood effects of completing a cognitive test battery, benefited working memory task performance and reduced total cholesterol and LDL.
Professor Lyn Griffiths took delegates through a presentation on migraine and genetics as well as studies which examined the use of folate, vitamin B6 and B12 in managing migraine.
She says there is a very promising body of evidence to show that regular use of these at an appropriate dosage can lower homocysteine levels in migraine sufferers and reduce the incidence of migraine episodes and severity. It’s a good example of using genetics to identify people affected by a condition and target them with treatment, she says.
Keynote speaker Dr Katherine Gergen Barnett (pictured) spoke of the importance of helping patients “upstream” while they are well (or less unwell) rather than attempting to help them “downstream” when many more people are more unwell.
She examined the global state of integrative medicine and highlighted the importance of using the term “integrative” as this term “reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, healthcare professionals and disciplines to achieve optimal health and healing”.
Pharmacy is increasingly the place where Australians go to get CMs, PSA’s Joe Demarte told delegates, but not where they get their advice – a situation pharmacists should strive to change.
“70% of Australians use complementary medicines and we know the use of complementary medicines is increasing,” Demarte told the conference.
“I note also that the trend is also towards more sales in pharmacy, with the latest research showing that at June 2015 54% of these products were sold in pharmacy as compared to 44% previously.”
But NPS Medicinewise data shows that friends and family, the Internet and health food store workers are where they get their information about CMs.
He says this may be due to the misperceptions in the community that any “natural” preparation is automatically safe.
Blackmores Institute’s Lesley Braun told the conference that “it behoves us all to be right on top of the latest evidence” as consumers get hold of it very quickly and will ask questions of their health professionals about it.
A good example is yesterday’s news about the role of oral vitamin B3 derivative in cutting the risk of new skin cancers, she says, as mainstream media reports have featured images of Vegemite and beer.
Consumers would need to drink 713 beers a day to get enough B3, she says.
“We have certainly moved on from the time when practice was informed by folklore,” she says, as the store of evidence expands into greater understanding of issues such as safety and bioavailability as well as efficacy.
“There’s no research” into complementary and integrative medicine is now an ignorant view which may be doing patients a “massive disservice”.