8 NEWS
8 NEWS
2 JUNE 2023 ausdoc . com . au
RACGP won ’ t quit NSW trial
Professor Charlotte Hespe .
Sarah Simpkins THE RACGP has backed a NSW trial of pharmacists diagnosing and treating UTIs to be safer and more scientifically robust than its Queensland counterpart .
The trial , led by the University of Newcastle , is starting and will eventually cover more than 1000 pharmacies across the state .
It begins with pharmacists prescribing antibiotics , followed by oral contraceptives .
RACGP NSW / ACT chair Professor Charlotte Hespe said the college was against pharmacist prescribing of any S4 medicines .
However , she accepted that the trial was going ahead with or without medical input .
“ What I wanted , at least , was to make sure the trial provided high-quality data
Optimal dosing opt in to life . * 1-5 with a safe protocol ,” she told AusDoc .
With the upcoming North Queensland pharmacy trial covering the treatment of asthma , diabetes and a host of other conditions , the RACGP walked out of its advisory role more than a year ago after deciding the trial was “ too dangerous ” for it to be involved at all .
But Professor Hespe said the NSW GPs consulted for
lets your PEI patients
the trial were able to push for safeguards , including rules that pharmacists who prescribed antibiotics had to inform the patient ’ s usual GP .
“ Pharmacists were also adamant that they could not do urine testing in pharmacies ,” Professor Hespe said . “ So we requested that every patient receive a urine collection jar , be told how to collect their urine and be asked to do that prior to starting the antibiotics .
“ If it looks like the treatment is not working or the patient gets sick , they can see their GP the next day , and the urine sample can be tested .”
NSW Health has confirmed that pharmacies would prescribe trimethoprim , nitrofurantoin and cefalexin as their first- , second- and third-line treatments , respectively .
And it said pharmacies must have a consulting room that was “ not a dispensary , storeroom , staff room or retail area ”.
Professor Hespe hoped the NSW trial would provide more robust data than the Queensland pilot of pharmacists treating UTIs , which ran from June 2020 to September 2022 but was not registered as a clinical trial .
“ If you are going to do a trial , you should make sure the trial is designed to answer the questions , particularly those around safety ,” she said .
“ If this NSW trial shows this model of care is safe , has the patient at the centre and is going to deliver high-quality care , that is a good outcome for everybody .
“ I have never been against working with pharmacy ,” she added .
“ I have only been against working with pharmacy when the outcome is about unsafe care that delivers pharmacy profits .”
*
Optimal dosing of Creon ® can lead to an improved quality of life . 1 – 5 Creon ® can optimise nutritional status and normalise digestion , pain , and bowel movements , which may improve QoL in patients with PEI . 5 , 6
Suggested adult maintenance dosing : 1 , 5 ® ®
PEI , pancreatic exocrine insufficiency ; QoL , quality of life .
PBS Information : Creon is listed on the PBS as a digestive enzyme preparation ( 10 repeats ). Restricted benefit : for cystic fibrosis patients under a GP Management Plan or Team Care Arrangement ( 21 repeats ).
Before prescribing please review the full product information available on request from Viatris or telephone 1800 314 527
MINIMUM PRODUCT INFORMATION : CREON ® CAPSULES ( pancreatic extract 10,000 , 20,000 * 25,000 , 35,000 , 40,000 * BP ) CREON ® MICRO enteric coated granules ( Pancreatic Extract ) INDICATIONS : Pancreatic enzyme replacement in paediatric and adult patients with pancreatic exocrine insufficiency ( PEI ). PEI is often associated with , but not limited to cystic fibrosis , chronic pancreatitis , pancreatic surgery , gastrointestinal bypass surgery ( eg . Bilroth II gastroenterostomy ), ductal obstruction of the pancreas or common bile duct ( e . g . from neoplasm ) CONTRAINDICATIONS : Hypersensitivity to porcine protein or any of the ingredients . PRECAUTIONS : Fibrosing Colonopathy , Pregnancy , Lactation . INTERACTIONS WITH OTHER MEDICINES : Antacids : Antacids should not be taken at the same as time as with Creon . If necessary , it is recommended that at least one hour should elapse between use . ADVERSE EFFECTS : The most commonly reported adverse reactions were gastrointestinal disorders and were primarily mild or moderate in severity . Common adverse reactions included , nausea , vomiting , constipation , diarrhoea , abdominal distention , rash , pruritus , urticaria , abdominal pain . Some of these adverse events are similar to the symptoms associated with PEI and underlying conditions . DOSAGE AND ADMINISTRATION : The capsules : Capsules should be swallowed without crushing or chewing , with enough fluid during meals . If unable to swallow capsules , open and add minimicrospheres to acidic soft foods and consume immediately . Do not chew or crush minimicrospheres . Ensure that none is retained in mouth . The dosage should be individually titrated and depends on the severity of the disease and the composition of food . Cystic fibrosis : 1,000 lipase units / kg / meal for children less than four years old ; 500 lipase units / kg / meal for those over age four . For adult patients with PEI associated with other conditions , initiate at 25,000 to 40,000 BP units of lipase per meal and half of that dose for snacks . If required , 80,000 BP units of lipase per meal and half of that dose for snacks . Max dose 10,000 units lipase / kg body weight . The granules : Can be added to acidic soft food . The scoop provides 100 mg or 5,000 units of lipase . Any mixture of the granules with food or liquids should be used immediately . The dose is adjusted to the fat content of the meal and the severity of the disease . Cystic fibrosis : 1,000 lipase units / kg / meal for children less than four years old ; 500 lipase units / kg / meal for those over age four . Most patients should remain below 10,000 lipase units / kg body weight per day or 4,000 lipase units / gram fat intake . * Not currently marketed in Australia . Minimum PI updated : 21 April 2021 .
References : 1 . Smith RC , et al . Australasian guidelines for the management of pancreatic exocrine insufficiency . Australasian Pancreatic Club , October 2015 . Available at : https :// www . pancreas . org . au / resources [ Accessed January 2023 ]. 2 . Sikkens EC et al . J Gastrointest Surg 2012 ; 16:1487-92 . 3 . Kuhlmann L et al . JOP J Pancreas ( Online ) 2018 ; 19 ( 4 ): 183-89 . 4 . Keller J et al . Gut 2005 ; 54 ( Suppl VI ): vi1-vi28 . 5 . Creon ® Product Information . 24 January 2022 . 6 . Ramesh H et al . Pancreatology 2013 ; 13 ( 2 ): 133-39 .
Creon ® is a Viatris company trademark . Copyright © 2023 Viatris Inc . All rights reserved . Viatris Pty Ltd . Level 1 , 30 – 34 Hickson Rd , Millers Point , NSW 2000 , Australia . ABN : 29 601 608 771 . Call : 1800 314 527 . Date of preparation : January 2023 . CRE-2022-1126 . MYL0752 .
College axes discounts
Antony Scholefield THE RACGP expects to add $ 8-9 million to its coffers over two years after shutting down various discount membership categories .
In April , the college announced it would raise fees by 4.2 % and whittle down its membership offerings to focus on two main categories — full fee and concessional — with a small number of discount categories for IMGs , registrars and doctors aged 70 or over .
The full fee has been set at $ 1567 and the concessional fee at $ 940 .
Following a last-minute change , GPs earning less than $ 150,000 a year before tax from all revenue sources are eligible for concession rates .
With a round of redundancies — 50 jobs axed in March — the college said it had hopes of an operating surplus in the 2023 / 24 financial year .
In the past financial year , its expenditure reached $ 130 million .