Medication harm reduction trials detailed

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Chronic kidney disease, osteoporosis, medication-related problems and community-based medication reviews are among new pharmacy projects green-lighted by the Federal Government

Health Minister Greg Hunt has announced that the Australian Government is investing $11.7 million in medical research for pharmacists to support patients with the safe use of medicines. 

“All Australians will take some form of medication throughout their lives for a number of reasons, but using medicines are not without risk,” the Minister said.

He cited recent research which estimated 400,000 people present to emergency departments with medication problems each year, and 250,000 are hospitalised – and which suggests half of these events could be prevented. 

“The 2020 Quality, Safety and Effectiveness of Medicine Use and Medicine Intervention by Pharmacists grant recipients tackle some of the common prescription drug issues for at-risk groups,” Mr Hunt said.

“This includes the growing number of Australians – more than 1.7 million people – who aren’t aware they have symptoms of chronic kidney disease (CKD). For this group, some medications are dangerous and can cause toxicity in the kidneys. 

“As part of this program, University of Sydney researchers will receive almost $1.9 million to pilot a CKD screening program by community pharmacies, to identify and manage patients with the disease.”

This trial will be led by Dr Ron Castellino, a renal pharmacist and senior lecturer in pharmacy.

The trial will provide community pharmacists with tools to identify patients at risk of chronic kidney disease. This screening will allow pharmacists to provide quality services regarding use of medicines, identify medications that are toxic to the kidney or potentially inappropriate for kidney function, and recommend ways to optimise use of medicines. 

“The University of Sydney will also receive $2.3 million to develop an integrated referral pathway for Australians with osteoporosis, to help decrease the risk of falls by reducing the use of medicines that lead to falls and improve the use of anti-osteoporosis medicines for bone strength,” Minister Hunt said.

Associate Professor Rebekah Moles will trial a referral pathway, led by pharmacists, which reviews the medications of consumers with osteoporosis who have sustained a fracture.

Her intervention aims to reduce the use of medicines which lead to falls, such as those causing sedation, while improving the use of anti-osteoporosis medicines that improve bone strength. 

Another trial will examine a systems approach to enhancing community-based medication review.

This trial will be led by the University of Sydney’s Professor Timothy Chen, whose work in medication review led to the establishment of the Commonwealth-funded HMR program 20 years ago.

This MRFF project will build on key elements of the HMR program to enhance the quality use of medicines in primary care.

It aims to build better systems for pharmacists and medical practitioners to work together for the benefit of patients at high risk of medication misadventure as they transition from hospital to home.

An important component will be the establishment of Drugs and Therapeutics Committees within Primary Health Networks and the appointment of medication safety pharmacists to facilitate community-based medication management and the safe and quality use of medicines.

Professor Andrew McLachlan, Head of School and Dean of the Sydney Pharmacy School said, “These three exciting projects, led by researchers in the Sydney Pharmacy School, address critically important research to address the global challenge of medication safety.

“Pharmacy research leaders have assembled outstanding multidisciplinary teams, including important collaboration with consumers to co-design projects, that will investigate and implement interventions to significantly improve quality use of medicines and reduce the burden of medication related harms.”

Another trial, co-led by Griffith University and QUT, will work to decrease the number of medication-related hospital admissions.

The three-year collaborative study will use health record data to automate the detection of medicine safety issues before harm occurs.

“In Australia, 250,000 hospital admissions and 400,000 emergency presentations per year are due to potentially preventable medication-related hospitalisations,” said Dr Jean Spinks from Griffith University’s Centre for Applied Health Economics.

“Medicine safety can be targeted in primary care by identifying people at greatest risk, undertaking interventions in a timely way and ensuring the health workforce can resolve problems before harm occurs.”

Pharmacists, working collaboratively with GPs, Primary Health Networks and Aboriginal Community Controlled Health Organisations (ACCHOs), will systematically address issues such as under prescribing, over prescribing or incomplete therapeutic monitoring.

Professor Lisa Nissen from QUT School of Clinical Sciences says an important part of the trial is the co-design of the intervention with both consumers and health practitioners.

“This is something new for consumers, pharmacists and GPs, so it is important to ensure that these groups have input into how the intervention will work,” Professor Nissen said.

“One group we are particularly focused on is Aboriginal and Torres Strait Islander people, who use a lot of medication for chronic disease and may have reduced access to healthcare.”

Also green-lighted was the ALLIANCE trial, led by Monash and using pharmacists to provide contraception information to women seeking emergency contraception.

This trial made headlines around the country this week and was widely misconstrued by reporters and the public, one of its researchers, Dr Safeera Hussainy, told the AJP on Tuesday.

“The trial was recently misrepresented by some as mandating counselling prior to women being able to receive emergency contraception (formerly known as the morning-after pill) or medical abortion medication,” said Professor Danielle Mazza, Professor, General Practice, Monash University in a statement since.

“The reality is quite different.

“Instead, the ALLIANCE trial will provide women with the opportunity to receive evidence-based information about all of their contraceptive options in a private consulting room in the pharmacy from a specially trained pharmacist. This offer will be made after the woman purchases emergency contraception (ECP) or fills their medical abortion prescription.

“Should the woman decide she wishes to pursue the contraceptive pill or an IUD or implant, the pharmacist will refer her to either her GP or other local services where these contraceptives can be obtained.”

Minister Hunt said that the outcomes of the research undertaken through the grants will help inform ongoing work to ensure pharmacist fulfil their full scope of practice and could also inform the future Community Pharmacy Agreements. 

“The grant program is funded through the Australian Government’s Preventive and Public Health Research Initiative, which forms part of the Medical Research Future Fund (MRFF),” he said.

“The initiative is about supporting innovative approaches to public health challenges, particularly treating and managing chronic and complex diseases and improve the use of medicines. 

“The Government’s $20 billion MRFF is a long-term, sustainable investment in Australian health and medical research helping to improve lives, build the economy and contribute to the sustainability of the health system.”

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