Dreaming of What Pharmacy Could Be

 

When will things change?

How about putting the CARE back in healthcare? 

When you imagine a better system, what does it include? Shortstaffed, stressed out, or defeated professionals? pushing margins, manipulating patients, and being untrustworthy?! Surely not. 

Take time dont take numbers. We value what is enforced.  We consider only that which is legislated - especially for the highly regulated field of pharmacy! 

So how about pushing pharmaceutical and pharmacological interventions rather than paperwork? How about enforcing pharmacist authority rather than unqualified owners. How about turning back to patient care rather than client care, how about being a health hub rather than an all carrying shop; how about promoting health rather than promoting profit; can we realise that prevention is indeed better than cure? Can we invest in prevention campaigns rather than amortization of disease impact? Can we just do what we are all called to do: help one another in honesty and fairness for the sake of a healthier nation?

hmmm, so where is council?
Their role to protect the public should extend to what they allow corporations to do. 

Squeezing pharmacist with ridiculous targets directly takes away from the PATIENT CARE they ought to provide. We've all witnessed it.

 
How about inspecting on pharmaceutical care  rather than on administration, how about observing counselling and consultation sessions rather than scrutinising uncompromising details. How about protecting the public rather that protecting the law.
I wish for a healthcare system that matters on effectiveness. Where proffesionals are allowed to practice freely under oath and not at the mercy of their business oriented employers. I wish for a pharmacy industry where pharmacists are not begging for lawful peanuts while Multitasking over the work of 3...

What about primary care or referals? Where NdoH & council determines that patient care & safety includes a completion of service note where a referal letter to the patient's gp stating what has been observed and discussed at the dispensary, as evidence of primary measures taken... using new tools to improve escalation of care is such a fantastic idea!

 Then only will pharmacists as primary health care professionals be taken seriously. 

Dreaming is fun and ideas are great but nothing will change without genuine will and implementation. 

Let me go back to sleep. 

One Degree Many Careers

This short piece is a small flex just to highlight another amazing aspect of pharmacy!
Having a pharmacy career is really cool. It has its ups and downs like spoken of in a previous video, but here are 20 new reasons to love it!

You've surely heard of a retail pharmacist and a hospital pharmacist. Maybe even of ward or clinical pharmacist. But have you ever heard of a clinical trial pharmacist? Or a research pharmacist? A warehouse or distribution pharmacist? Inport? Export? Maybe those were simple, how about a nuclear or radio pharmacist? Pharmacokinetic pharmacist? These are just a few of the many specialties within the vast pharmacy world.

Lecturers are also pharmacists; obviously they teach it to students but did you know that they also run national drug programmes, and suggest policy to goverment and regulatory councils? There are toxicology pharmacists? Regulatory affairs, validation, documentation, drug discovery/design pharmacists. Quality assurance, quality control, and technical support pharmacists!

Tell me which other careers path has this many options? I'll wait...


Haha, hey thanks for indulging the flex.

Subscribe to our channel and other platforms for more pharmacy news, fun and debunking!

Till next time xoxo
Love Pharmacy

Halfway through the SA COVID-19 lockdown | Observations

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So the entire world has been on lockdown for a while now; each country at it's own schedule but here in South Africa we are on  the afternoon of day 10 of 21. Exactly halfway though confinement, quarentine or self isolation depending on the term you prefer.

I've made some personal observations which I'd like to share with you below;

☆Leadership and governance:

It seems for once, many were happy at government's decision to lockdown the country (borders, & unnecessar gatherings and travel). Critics were still unsure about how to feel and wanted intricate detail but in the end saw the wisdom in it all. with the unique healthcare status and needs of the nation, such a pandemic could not be allowed to freely settle in. High HIV and TB patients populations mean many compromised immunities, compounding to the normal asthma, copd, and smoker's lung, all amount to higher disease burdens. This coupled with extremely poor, densely populated, infomal communities would set the infection, transmission and fatality rates ablaze.
T'was a good call to lockdown the nation.  The "curve" has already flattened and the death toll remains in the single digits. Now to provide sanitary assistance to these communities is the next urgent step which they've promised to make.  

☆Selfishness and hoarding: 

Panic buying images flooded the internet as soon as the lockdown was announced. They quickly became the viral memes of each day. Long queues at wholesalers couldn't go unnoticed as this highlighted not only the privilege often spoken of, of those who have extra savings, vehicles and storage to stack trolleys and trucks in some instances without concern for others. But also the entitlement, and nasty attitudes from those called out despite the repeated warnings to ration supplies and that grocery store would not be closing. I remember an ENCA news presenter checking us all when he said: check your privilege! This was directed at commenters complaining that township habitants queuing at shops for groceries seemed "late" and "ignorant" while they had only just gotten paid/ grants, and were then doing the same as the first priviledged group. 

☆Solidarity and selflessness: the above negativity led to an almost reciprocal positivity spilt between solidarity and selflessness with many showing compassion towards others and donating to shelters and charity. My feeds were inundated with requests to donate and lend a hand or even volunteer. Humanity still lives and kicks in many hearts! This was beautiful to see and must be commended.  Many companies quickly provided hand sanitisers and sent their staff  to work from home. I personally also received many emails from companies reassuring their clients of measures in place to minimize inconveniences and disruptions. Comforting!

☆Fear and faith: 

Then on the spectrum of motives, many were driven by fear while fewer resorted to faith. Churches were praying together until the ban, and switched to live online stations while others were fixated on news channels further feeding their fears... we were not only fighting an invisible virus but also a much more devastating invisible spirit of fear. Today, it seems fear is quenched and under control. The lockdown circumstances have become a new normal and we have all adjusted (as best we can). My encouragement to all those still gripped by fear is to focus on the solutions, not the problems. These solutions are hygienic measures, confinements, healthy eating, immune boosting and practicing peacefulness (quality happy times, meditating, praying, playing games, exercising etc). You can't change the problem but you can replace the time spent pondering on it with solutuons. 

☆Ignorance and unpreparedness: 

They usually say "stay ready so you don't have to get ready" but in this case people's general unpreparedness was suddenly exposed along with their accompanying ignorance in handling infectuous or communicable diseases. Now to be fair, my antiseptic training in pharmacy school and later in oncology drugs handling has given me a stark advantage; but basic hygiene and "no touching" from primary school should've assisted everyone else at least a bit more. It was shoking to hear some people complain about washing hands etc. Till today, the concept of cross contamination with/without gloves + masks and disinfection of surfaces still evades most.  I always cringe when i see someone with gloves touching their phones and clothing or taking their mask off to cough or sneeze! Perhaps here's an opportunity for individuals, companies and governments to put in place messures for handling similar outbreaks and improve overall preparedness for the future.

☆Essentials vs Non-essentials:
In a time of crisis, focus shifts towards what's most urgent and important. The  concept of essential vs nonessential distinguised and reclassified all our professions and everyday items. Essential services quickly became the theme for praise and gratitude, (and this must therefore mean that when we all go gack to normal life, these very 'essentials' should be compensated and their wages/packages reviewed and improved right? especially low or minimum wage workers like cleaners, security, etc.) although mostly directed at doctors and nurses, we had to include PHARMACISTS & their ASSISTANTS to the mix as cornerstones of healthcare in research, clinical trials, medicine manufacturing & production as well as dispensing among many other crucial roles they play.

Even with selecting shopping centers and essential items, slight confusion arose when no consistency was initially observed from outlet to outlet. In some shops you couldn't buy shampoo or face wash, while in others even clothing was still available.  I think by now all nonessential sections are blocked off in all stores. (I wonder who determines what is actually essential and for who? Pregant moms and newborns surely need a lot of the stuff thats blocked off? What about my reading frames that broke and my lens which came out? Opticians are also closed and now I can't read till next weekend..!?)
Oh well, it is what it is; no one will be 100% comfortable in these conditions.  Im grateful theres no real emergency item I can't wait the16th for. How are smokers doing?

We also saw things like traffic and casualty cases drastically reduce. Nonessentials are really clumsy! (jokes)

At the end of the day, we are all we have. Lets be each other's keepers. Lets check on friends and family. Some are lonely and need a phone call. Others are in need of something you may help with.

Africans unite in your beloved Africa;
 fly the UBUNTU flag higher than ever.
We shall emerge stronger. 

Pharmers Blog

www.pharmers.co.za
Pharmaceutical expertise and care!

Leave a comment! Share your experience.  Ask a question:  info@pharmers.co.za

CoVID19 ABC's and 123's

The virus, is here and there.  It has reached almost everywhere.

Do not fear; get informed.

First of all; fear does nothing for you. All the agitation much like rocking in a chair will get you nowhere.

Find reputable sources for updates. Listen  to rumours only for banter and use sound judgement to discern between the two.

Pharmers is a pharmaceutical consulting business which offers a handful of services. Sound pharmaceutical advice and preventative care services are some examples. Do not hesitate to ask your questions or send comments to: info@pharmers.co.za 

Our CoVid19 statement to our valued members and to the public  is an ABC acronym for easy remembering. It stands for:

A LWAYS wash your hands with soap,

B EFORE touching your face or eating, &

C LEAN your commonly shared surroundings, and surfaces using disinfectants, often.

Simple and effective.

Also remember these 3 things:

1) boosting your immune system (whether using herbal  or chemical remedies) is not going to prevent you catching an infection, you will still carry the pathogen.  It will only help your immune fighters to better cope with the infection and possibly render you asymptomatic in the best case scenario (but still a carrier able to infect others).

2) the best way to prevent an infection is to reduce the probability of contracting it through  physical touch - hence the heightened personal hygiene recommendations and frequent surroundings disinfection as well as reduced contact with others/isolation.

3) be compassionate.  We are facing frustrating times. Buisness as usual has changed, schools are closed, functions and events are cancelled...  Be kind and understanding. Use this time to introspect, reconnect with your reality and realise how frail we all are in the face of microscopic agents; lets remain humble and grateful for what we still have.

Two national SA Covid19 helplines operating 24h a day are: 
0800 029 999 and 0800 111 132. 

#pharmers

#pharmacy

www.pharmers.co.za
Info@pharmers.co.za

Pharmacists: show your preventative care in 5 ways

If you're a pharmacist you might start feeling guilty as soon as you read through the checklist that follows and find that you've fallen short on your duties!

Have you in the past year:

• Initiated & monitored patient therapies
• Conducted/initiated community health talks
• Conducted/initiated health expos/ campaigns challenges or competitions
• Led/ participated professionally in health awareness days
• Led/participated professionally in health screening days
• Demonstrated pharmacological and pharmaceutical expertise in patient interactions or interventions 
• Acted in any other intentional health promotional activity

If you have done some or all; that's excellent  [insert pat on your back] but  the reality is most haven't. Did you know that this is part of your scope and uties as a professional sworn pharmacist? Without getting into the numerous reasons why many have not regardless of subfield or sector; lets try and highlight a few crucial reasons why you now should reconsider. Get involved today!

Shocker: The Global Disease Burden quickly rising with many preventable illnesses, diseases and deaths occuring on your watch. 🙈

1) don't be shortsighted, the smallest act matters:

If you dont plan to intervene on purpose, it will never happen or become effortless.

E.g. lady comes in for morning after pill. You give her the form she signs and you issue the pill.

Now If you had planned for intentional preventative care, you would inform her that as part of preventative care you'd like to add value to her purchase by enquire about her (their) past experiences/concerns if any, with STI's / STD's and offer measures on how to prevent them in the future. Having pamflets ready greatly assist with this. Offering (free where possible) HIV screening to know her status and handing out (free) condoms would also supplement the encounter. Highlighting risks can steer even one person clear. If response is favorable and you notice a trend or young students from a campus near by (school/college/university), go as far as asking for contacts to plan a sexual health talk in a relevant upcoming session/event. 

Even if youre not in retail or hospital don't think you are left out, local park runs, weekend expos and many other community events need you to volunteer. Speak to the organizers. Get a few colleagues together especially interns and students to put together a short 10mins relevant talk  before or after the event.

2) don't outsource, YOU are qualified:

Pharmacists are more than able professionally (and within scope) to conduct primary (preventive) health care. You can do most screenings, immunisations, counselling and basic diagnoses (s3: self limiting)! If not get a PCDT pharmacist who can. Add medication management and reviews and you've got yourwork cut out for an entire day/event! Don't employ additional proffessionals if you dont have to.  Nurses and physicians are great but they will never be pharmacists.  In a pharmacy  you alone have the entire holistic view of the patient's condition. Show expertise. Your call on the actions to take will be most wholesomely accurate. Plus, we are trying to shine the pharmacist light. The other professionals can campaign for themselves! 

If you must outsource, stay on top of things and in the know. Your pharmacology and pharmaceutics are your unique differentiators. Incorporate then in the care process. 
 Never let such a huge aspect of your patient's care be completely out of your hands. Follow ups will be difficult if you don't partake.

3) Do anticipate trends, timely and tailored: 

If the majority of your patients are diabetic, conduct diabetes awareness days, talks, management series etc.  Serve the specific needs of your patients while preventing many more from developing the disease, complications or  deteriorations. Metabolic diseases are majorly lifestyle disease, show the correlations, and tie them up together to demonstrate "cause and effect". Mental health is still very entwined yet ignored, stats will shock and awaken your crowds. Have no sugar days (and I dont mean substitute real sugar for the fake toxic carcinogenic stuff); do biggest loser competitions too and include kids and teen! Both reap tremendous health benefits in the long run. 

4) Do offer prevention products & services:

Preventative vaccines such as those for Influenza or HPV have been demonstrated to greatly reduce disease burden. Especially in the risk groups.

Health isles with preventative medicines such as supplements, boosters, aids etc may also offer great support to patients but still require your expert advice (even if just on cost, effectiveness, combinations or comorbid risks). Couple these with screening services and run monthly competitions for the ultimate "Preventative Care" packages. 
Keep them interested. 
You may already offer these services indivudually but renaming and regrouping them can have a unique flair and appeal.

Encourage healthy weight by measuring patient BMIs to stay within ranges and offer to assist those who fall outside of margins with nutritional supplements or referrals to nutritionists/ dieticians as needed.

5) Do support your patients:

Perspective is everything. If you refer to them as clients or customers, you lose the care aspect to when they are patients. The power dynamics shift and power struggles result. 

Show your patients you care by putting their health needs first.
Smoking cessation is another big topic to tackle, offer close monitoring, otc gums or patches and if needed referals but ultimately patients want to feel heard and understood.  Acknowledge their struggle. Often  the smoker only needs your professional push and assistance to quit/start the quitting journey. Have that chat with them highlighting positive effects and avail yourself. Establish channels and create quick/easily accessible directories/ contact lists. Imparted confidence is what every patient needs to succeed.

There is a lot of work to be done and patients need to see this happening.  Pharmacy is not just pills. Phamacy is you and your added value to therapies.

If you're not a pharmacist atleast now you know all the services you should be able to benefit from; go ahead and request them.

#pharmers

#pharmacy
#preventiveCare
#forTheLoveOfHealth

Upcoming Festive Overindulgence? Try These 4 Tips to Overcome

If you're a part of the majority, you've already set off on the overindulgence 'ke Decemba' train. The month of December is inherently filled with weddings, birthdays, funerals, holidays which all equate to food, food and more food!

There's no need to panic, here are four tips to avoid bloating,  weight gain (water retention), tummy upsets and toxins buildup which can trigger joint pain and other inflammatory conditions.

All suggested medicine are available OTC from your local pharmacy and do not require a prescription. Ask your pharmacist for advice if in doubt or taking other medication concurently. 

 Firstly, liver support - whether you plan to drink or eat more than usual, substantiate your levels of essential phospholipids  with supplements  to assist your liver in its metabolic functions. 1 or 2 tablets up to three time (8hly) a day with food will do. 

Secondly, consider a hydration supplement.  In the heat of the summer, we tend to sweat  (salts are lost) and lose water a lot more than in winter. Increasing our water (fluid) intake is great but a step further is replenishing our electrolytes along with it. This keeps the "thirsty" feeling away and curves more subsequent cravings by maintaining feelings of satiety. One sachet dissolved in a liter of water as required on very hot days will do.

Next, lets consider excess acid levels. PH levels are critical to healthy body tissue states. Alkaline states help your system to better prevent cellular inflammation and  tissue injury/disease. Take an alkaline powder (7.5g) once or twice a day with a glass of water for a good week or so before and during the festivities to curb over acidity in the entire body. 

Lastly, its a good idea to add fiber to your diet. By sprinkling some on your food or in your drink, you ensure your gut remains regular and eliminates waste timeously.  Constipation often results from overindulgence of high sugar, high fat and low fruits/veg diets typical of party foods. Try soluble fibres to avoid this.

Whatever you decide to eat and indulge in, always keep moderation at the back of your mind. Portion sizes matter. Start with the salads and the greens before heading for the meats and the desserts.  Drink water before you leave the house as a prep to redu8ce your overall appetite, while conditioning your digestive enzymes for incoming food. 

Prevention is always better than cure. 

Enjoy your holidays, have a merry Christmas and a happy new Year 2020. 

Stay safe. 

Pharmers 

www.pharmers.co.za 

Antimicrobial Resistance; What's the big deal?

Imaging getting to the hospital for a severe bacterial infection and being told:

Sorry we don't have any effective treatment to give for this stain anymore!

That's where the world is heading;

We are dangerously close!

Listen up: in as little as 10 years we could have run out of options to treat all the super bugs currently being mishandled.

How exactly is antimicrobial misuse linked to resistant strains and treatment failure?

I'm glad you asked;  every time you take an antimicrobial medication incorrectly (dose, duration, frequency, type, or treatment option) you actually give that bug, or others around it a taste of what was supposed to kill it; but instead with this "taste", the bug incorporates the drug in its DNA and subsequently becomes enhanced, empowered and immune to it. 

This simplified explanation is to tell you to be very careful with your medication. When in doubt, ALWAYS ask your pharmacist to explain and confirm your treatment. 

Unfortunately, power struggles in the medical sphere sees a rise in patients demand towards their prescribers (every condition is a suspected infection that requires antibiotics), as well as many prescribers' carelessness in prescribing patterns. With many taking shortcuts when it comes to correctly identifying causative agents. These compounded tragedies are leading us to a point of no return. 

The 4rth industrial revolution is bringing along an unimaginable microbial disaster; if nothing is done. 

Prescribers: be careful. Resort to antimicrobials under extraordinary precaution and care. 

Dispensers: be careful. Counsel and warn your patients with utmost clarity, providing treatment assistance and reminders.  

Patients: be careful. Do not demand from experts what you think you know. They will provide the best treatment option if you remove your "paying-customer-is-king" pressures from their sworn responsibilities, lengthy degrees, and daily clinical experiences. 

Let's all work together in care and respect.  

#Pharmers

#pharmacy 

#antimicrobials 

#stewards

#healthCare 

NATION HEALTH INSURANCE - Should SA Panic?!

Since the signing of the bill and the declaration by government to go ahead with the NHI plans, many have been gripped with fear and consequently have been spreading it to others like wild fire. There seems to be a general negative connotation within the South African environment at the moment with regards to universal health coverage. 

  

A few myths have crept up which we can quickly put to rest: 

-Will the 20% fund the 80% ? 

-How can a system which is already struggling stretch any further? 

-Will the funds be squandered or the entity managed like Eskom and others?

To begin, let's establish a few truths!  

-No health care fund/ system or reform ever began once the nation was "ready" or in an overall "better/good state". The UK for example implemented their NHS after the war when the country was poor and struggling. 

- Neither the current public nor private sectors are doing well. A system change is inevitably needed and a new funding model is a great tool for that change to begin.

- Already 8% of the current GDP is spent on health, how much more can they inject  into health, being at the upper threshold already?  An efficient system is encouraged.

- Most of those who spread fear and negativity have not actually taken the time to read the bill nor have they made contributions to the open documents that exist for commenting:

(https://dearsouthafrica.co.za/national-health-insurance-bill-2019/) 

The NHI is a fund; which will be managed as a schedule 3A public entity and therefore a lot more strictly regulated as opposed to Eskom and the likes which are schedule 2 entities. This means centralize admin,  specific committees,  monthly rationing etc  This fund will also not solely come from tax payer increases as some imagine but mostly from a pool of tax shifts, payroll tax, medical schemes, and surcharges on PIT among others. The "20% cannot and will not fund the 80%"! Everyone is contributing proportionately. 29% of unemployed youth do not represent 80% of the population and payroll tax is only one source of funding as mentioned above. 

Additionally, with the concerns around implementation, phases are being rolled out until the official 2026 full implementation.  Therefore, the "readiness" will inadvertently be ironed out progressively through each phase. For example medical aids will continue as usual until legislation (about 12 of them in total) changes and their new scopes are redefined. 

The issue of staff shortage, is also going to improved. Currently, for every medical practitioner in the public there are five in the private sector; they are concentrated in certain urban areas. By allowing public and private to mix, this ratio can shift resulting in a wider population reached and serviced.  A similar story can be told about facilities where the majority of public facilities are flooded with patients while in private, many institutions have for instance 30% occupancy thus waste resources, charge more to make up for them and hence treat populations inefficiently. Sharing workforce and infrastructure to all patients  will improve efficiency. Of course a point to upgrade and train adequately should be made and is included in the model for sustaining health care services. 

Many have also raised the question on pilots failing? First of all pilots don't fail! They are a testing tool to assess a new avenue. Therefore the "failed" reports can only serve to improve each phase design and implementation onward.  Also, the NHI in itself could not have been "piloted" as the fund setup and other details around it require legislation changes first. Rather, the pilot sites used for testing have had mixed reviews due to poorly documented techniques and results, thus revealing poor  research strategies (copy and pasted plans did not get necessary tailoring per district) as opposed to poor concepts. To understand the value of the roll outs (pilot sites), just ask the primary beneficiaries: the patients who previously had to queue the night before or the full day of collection to receive their chronic medication;  who have already began to receive their chronic medication parcels in many external pick up points of rolled out districts and they are overflowing with gratitude at their new found efficient access to health care.   

One more thing to consider is the majority.  let's put ourselves in the shoes of the poorest; those who have no option, and no alternative. As the privileged bunch, let's not think that attempting to provide for others, is an oppressive attack on ourselves. The search for equity is primordial.
The more we empower people to contribute, the more we also enable them to consume and have options. The right to access quality efficient health care should immediately be followed by the responsibility to contribute towards it. The new health care system will thrive as more patients escape the poor / unemployed / uneducated pool, take on employment and healthy lifestyles which decrease disease burden overall.  Patient education is key. 

 No system is perfect. Any alternative model (suggestions rather than complaints are welcomed) would also have flaws. However this is the option that was chosen and government should now run concurrent models (for example the voucher model) in various districts to establish which model variants work best, confirming their choice. 

It's also important to note that universal health care is not a SA concept. The rest of the world has already fought for decades to try and reach it. The WHO is mandating for the rest to follow suit in their vision 203p for the whole world.

Affordable care and quality care seem to be at opposites of the spectrum. How can they both exist unless some win and some lose? How does equality and equity factor in together? Until we stop viewing the fund as an all or nothing ideal, we will miss the many nuances in between. Being for the NHI doesn't have to be at the expense of precautionary scrutiny and acknowledging evident complexities. 

 SA should definitely NOT panic, rather shake the fear, toss the negativity and get involved in the deep understanding of the great need, the many benefits, and mitigating the flaws, while actively participating in the shaping of the NHI and the ideal health care system which is envisage for all.


#NHI
#Equity
#transparency
#joinTheConvo

#HEALTHCARE
#universalhealth


#PHARMERS by www.pharmers.co.za 

Pharmacy - Cornerstone of Health Care!

Whatever disease, illness or condition you may come across (go ahead and think of at least 3), part or the entire treatment protocol will require medicines. And who says medicine says: PHARMACY!

Who's in charge and running (around in) the pharmacy? Pharmacists of course! With the help of their assistants. 

But that's overly simplified you might think. Medicines being sold in a pharmacy don't quite illustrate the entire health care scenery does it? So why is pharmacy cornerstone?

Well they give you the final products. The end valuable result of the complex pharmacy machine! That's not all! You see,  health care in essence is the organized provision of medical care to individuals or communities. As each component of care giving requires either consumables, medicines or tools; pharmacists are the only licensed, sworn in, and responsible authorities for safely providing these to everyone else.  

To provide quality health care, rigorous investigations must be done. Diseases, their cause and progression, their treatment or management etc is studied with the aim of curing or at least controlling the condition. Pharmacists do that. Any agent which causes a desired physiological response can be deemed a drug, how it works and should be administered to treat and cure diseases is the pharmacists' prerogative! If you're still not convinced,  consider the following concluding points.

5 ways pharmacists are the cornerstones of health care: 

○They manufacture ALL available drugs; no pharmacist, no medication. 

○They understand both sides of diseases: etiologies vs therapies; no pharmacist, no prescription, disease & drug gate keeping. 

○They have basic and advanced knowledge regarding Primary, Emergency and Secondary/ Tertiary health care; no pharmacists, no adequate intermediate resources connecting all treatment levels. 

○They ensure quality treatments from obtaining raw materials, to maintaining quality through storage, manufacturing, packaging, distribution, prescribed indications and patient use. No pharmacist, no quality treatment. 

○they are the ultimate health care multitaskers: making the actual medications, ordering and controlling supply, supervising staff, consulting & counselling patients, intervening in patient therapies, mediating between prescribers and insurance providers, referring or initiating care, teaching and educating communities, while running profitable businesses among many others! No pharmacist, no cross-disciplinary, functional health care system!

You just can't beat them.

Pharmacists remain the undefeated,  unprecedented but ultimately undermined,  health care professionals!

Love and respect your pharmacist. Be patient while your community pharmacist helps you. They are there to optimize your treatment (outcomes) and improve your quality of life but if you rush them and they make a mistake it could really harm you.




Brought to you by: www.pharmers.co.za

Pharmacy Blog 

Flu Virus - to vaccinate or not?

So you know by now every year when flu season is about to start,  (roughly a 13 weeks duration spanning from March to July) the influenza vaccine gets promoted through advertisement everywhere! So is this a sales gimmick or is there some real benefit to it?

Well it depends! Who's asking?

Young children (from 12months), pregnant mothers up to 2 weeks post partum, the elderly or the immuno-compromised ( esp HIV/TB), lung/chronic disease and co morbid patients, certainly will benefit from it. The advantage isn't as directly observable as one would think (not catching any virus/not getting sick for the entire season etc). It is more of a "lessening of risk" , or aversion of exacerbation from a viral infection, which is key! After vaccination, the special groups (those mentioned above) patient drastically reduces their risk of landing up in hospital due to severe infection and secondary complications (cardiovascular, pulmonary, etc). The burden of the influenza related hospitalizations depends on the transmission and virulence of the strain each year.

Let's mention the three strains which cause illness. Influenza A - most usual cause of epidemics or yearly outbreaks, Influenza B - less severe outbreaks and illness, mostly burdensome on children and the immuno-compromised individuals. Lastly, Influenza C - which caused minor respiratory illnesses.

However the influenza virus (including all infectious strains) is not the only flu-like virus in the air.
Rhinoviruses which cause the common cold are another huge culprit; the adenovirus, coronavirus and other viruses all thrive during the colder months as indoor ventilation decreases and human clusters (viral harbouring and sharing) increase. So you may still get a cold, or another viral infection or even allergies, which all involve sneezing, rhinorea and sinus congestion among others. NB: the flu has a sudden onset of symptoms, includes fever and body aches, git disturbances in children, sore throat, and running nose as differential.

The question remains, do you vaccinate or not?

Considering the above information. If you fall within this special group, the safe advise to receive is: vaccinate.

If you live or work (especially health care workers) with this special group including newborns/infants, avoid becoming a source of infection to them: vaccinate

If you fall outside of this group, are a healthy individual and have no additional risk: you can skip the vaccine

The trivalent vaccine (TIV) in itself is not a live attenuated strain (it contains three dead/inactivated strains of 2 different A strains & 1 B strain) , therefore the rumors of it causing the flu or other diseases are unfounded/unrelated. However, after vaccination, a mild localized irritation might occur which clears quickly.

Lastly, it is worth mentioning that since the flu vaccine is not long lasting (6 months longevity), it should be re-administered annually at the start of flu season (in SA it's March/April). This also means that if you've had the flu at the beginning of the season, you may still get it again towards the end even if you vaccinate.

Look at this table which shows reduction in severity of disease and morbidity in those who vaccinate vs not:

Heads up, Now you know.

ALWAYS ask your pharmacist for sound pharmacy related advise.

Happy flu aversion

Have pharmacists given up their power?

One of the biggest mistake people make is to give their power away by thinking they don't have any!

This couldn't be more true for most pharmacists it seems. As observed in the retail setting, patients increasingly tend to push their luck and demands towards pharmacists. While entitlement isn't right, times have changed and in this day and age, your professional identity has to marry your personal conviction of who you are in a way you may not have ever experienced before. You have to know who you are and what your strengths and weaknesses might mean to your workplace. Your authority, your jurisdiction, your territory can never be threatened. Don't allow it. On the flip side, you can't rely on your mere title or name tag to suffice in the respect department anymore that's for sure. Patients are notoriously earning their instant online degrees after a few google quick searches and are ready to challenge you - the professionally trained pharmacists with a plethora of misguided, misinformed and misleading statements, questions or comments amongst other atrocities.

The guts!

For such a climate, the winning pharmacists are those who not only know who they are and what their roles, duties, responsibilities and rights are, down to the T! But can equally voice them unafraid. Your pharmacy degrees are no longer enough! You need wit, confidence and a lot of assertiveness to add to the community pharmacy scene. Being nice was often a trait which meant bending rules, doing favours and being "understanding" for many dispensaries. To the point where often, this leniency happens at the expense of the pharmacy's rules, policies and even the law! 

Fast forward to today and community pharmacists are all paying for having given their power away and allowed their dispensaries to become fast-meds pubs on steroids. So what has being "overly nice" got to do with professional power? Everything! If you're familiar with the phrase "familiarity breeds contempt" then you know that when you repeatedly show soft kindness over any other traits such as sternness or even assertiveness, it often is mistaken for weakness...

What do opportunists do when they perceive weakness? Take advantage of course! 

*Wait an hour at the doctors, but if you spend more than 5 minutes at the pharmacy... someone has to apologize! 

*Ask how they know how to read a prescription but never understand nor value the scrutiny involved in cross checking each item for safety. 

*Worry about asking your doctor if you can switch to a generic, while you ignore the one who actually studied your medication's various formulations  kinetics and dynamics.

*The list is very long...

Patients keep asking the wrong questions while pharmacists keep giving their power away... 

Before they ask, tell them. Before they stray, restrain them. Before they run off to their prescriber, educate them. Unfortunately the damage is done and the only way to fix it now is to overcompensate.  Over explain. Have readily available guidelines policies or laws, provide overflowing therapy information, do superfluous continuous self study, and be astoundingly resourceful. You cannot be caught slipping, or not knowing.

In short, always add and verbalize value to your patients (and other health care professionals whom we haven't touched on in this particular blog) during usual services. They will start understanding and respecting your work better. 

Become aware of such gaps. Fill them.

Go the extra mile in your supervision and training. 

Be excellent.

Just a thought.

Fix your face!

We often discussed the issues surrounding pharmacy practice, but never in a progressive or helpful manner. It's easy to see what's wrong in a situation but we seldom find ways to improve issues or "fix our faces". A particular problem, and one that requires immediate attention is that of the public perception and resulting interaction with pharmacists. Now, many reasons exist for the cause and escalation of this problem but that's a discussion for a different day. 

For now let's look at some "common sense" tips pharmacists (and assistants) can implement to improve patient perception and value added/superior (retail) service:

Using the following scenario, notice the type of questioning and the rationale behind each. Much of the work pharmacists do is internal (screening, medication option selection, prescription reviews, dosage adjustments, comorbidities assessments, double checking etc) which can be mistaken for not doing anything at all so to make it more evident to patients, it needs to be voiced and brought to their attention in every way possible.

- don't let a session, no matter how quick, start and end without asking any questions. Questioning shows knowledge (which translates into more respect for the profession) and it opens doors for deeper interrogations on patient history which is required for optimal service and therapy initiation.

The mistake most dispensers make is that when patients request a product by name, they think the patient knows all about it. Sometimes this is true but often it's not. A friend, colleague or family member who isn't a health care professional might have recommended the product without putting much thought into it. It is our duty to check if it is warranted and safe for that particular person. 

When a patient isn't "engaged with" they assume they are automatically correct in their selection and the need or perception of requiring counselling is quenched. They might not realise that medicine is potentially dangerous. It always needs assessing, dosage monitoring and contraindication checks.  Always remind them that we are here to assist in medication selection amongst other things.  Even with repeat buyers (otc or chronic scripts), make sure to inquire about: who is it for? ( even when sent, the messenger's perception of that "pharmacist " will change)

What the need/problem is (establish it if new) and if there are any co-morbidities/ contraindications, allergies etc (dangerous factors to consider before initiating therapy). 

For repeat patients, inquire about the progress of therapy, is it helping, any side effects or noticeable changes etc?  

All these will let them know that you care, and are able & willing to assist further if need be. Boosting the "fix" to your face!

Scenario Example:  

Patient: good day

Medicine's Expert (ME): good day, how can I help you? 

Patient: I'd like some Mybulen please.

ME: sure, is it for you or someone else?

Patient: it's for my wife. She's in pain.

ME: where is the pain located and how sever is it sir? Does she have asthma, stomach ulcers or any kidney issues? Is she pregnant? 

Patient: hmm it's her neck, she slept wrong last night. No she doesn't have any of those things. But she has diabetes. The pain is average..

ME: alright, because she has diabetes, just be mindful that mybulen has antiinflammatories which further accelerate kidney damage in the long run. Therefore when possible opt for local pain relief such as Voltaren gel or transact patches which bypass systemic absorption and hence renal excretion.  

For now I can suggest you take a muscle relaxant combination like Uniflex if you really want tablets but rubbing it with an antiinflammatory gel should be sufficient. It relieves localized muscular pain, avoids codeine which can quickly become habit forming and provides a safer alternative. 

Patient: oh wow I didn't know that, thanks a lot. I'll take the uniflex and gel but also give me a mybulen just in case she shouts at me. 

ME: ok, just let her know that there are options next time she has pain. She should always inquire with the pharmacist for the best alternatives.

Patient: ok, you've been helpful. Bye now. 

Patient thoughts: 

*Wow they're really thorough!*

*they checked if the medication is safe for her!*

*they're really knowledgeable*

*maybe they can recommend something for my nom's illness* 

*I'll bring my script here next time*

Obviously this scenario is simplified and can escalate or be more complex but the idea is to always be inquisitive.  Fix your face, and we fix our profession. 

Hope this helps even one person and makes sense. What are your thoughts?

www.pharmers.co.za 

At home self testing HIV kits: progressive or destructive

There are always new items being sold in the pharmacy. Products and tools to improve health, and others that prevent illness. Lately, next to the common pregnancy tests are drug tests and even HIV test kits. They are also very affordable (not aimed at any specific class of people). Pharmacists need to be increasingly aware and sufficiently warned about products hitting their shelves. When I saw these for the first time, I immediate had mixed feelings and couldn't help but wonder: is this even legal? So many questions flooded my mind. What happened to the pre and post counselling? What do the positive test result patients do after? How do they cope? Who is accountable or responsible for allowing this? Where were pharmacists? 

Health care is such a basic primary necessity. It must be accessible and available to all but are we doing the public a disservice by exposing them to a potentially dangerous territory to which they are inexperienced? What are the pros and cons of having such test kit so readily available?

In the country with the  highest prevalence of HIV/ AIDS in the world (~19% of the general population) how do we approach the matter conscientiously? Is normalization the way to go? I don't have all the answers to these many questions but my unsettling intuition is alarming.

Yes, HIV is closer to a typical "chronic"  disease in its management today than it ever was but does that mean we lower our guard and efforts of detection and management? How about its prevention? Are we over it? 

Who is the kit targeted at? Conscious couples who want to engage in sexual practises and are being cautious? Or individuals who have been exposed/ at risk and now want to confirm infection? Let's be frank, those who buy them are not on the prevention side if things. In fact this tool might have a negative impact on the prevention spectrum. 

Isn't that what clinics were for? Free testing in the presence of a health care professional? What is the advantage of secrecy? Are people known to do the right/ healthy thing when no one is there to counsel them? I think not. Especially when a new younger generation of sexually active individuals have not been part of the intense campaigns that once were efficacious in preventing STIs and HIV

Nowadays youngsters are desensitized and the illness is de-stigmatized as perpetrated. Not that stigma is positive in itself, but in a context of at least deterring some, it was useful.

Can we leave the numerous already existing testing methods alone and focus on heightening prevention methods. Prevention has always been better than cure, especially when there still is no official cure. If we start preventing more than detecting, perhaps numbers van go down and new infections can cease. What happened to: no new HIV infections by 2020? Or was that not a thing?

Can we ask psychologists on how behavioural patterns are modified when susceptibility perceptions drop? When new infections or disease stigma disappear? But why don't we? Perhaps big pharma doesn't really care. This is just another money making tool.

The number of undiagnosed and untested individuals is high, but encouraging people to test in clinics is better than leaving them to depressive disorders or dangerous behaviors in the case of positive results. 

If anything is going to be sold in a pharmacy, pharmacists should at least stand up for patients who cant defend themselves and refuse such practises. It is dangerous, irresponsible and seldom beneficial.

Shocked,  saddened and confused.

Prescribers' scribble; Dispensers' struggle

Poor handwriting is a common cause of error in 100% of dispensaries across the world. In SA, most prescribers think that money is more important than lives, therefore they hurry on scribbling things away unbeknownst to the patients who often leave the practice confused and unsatisfied. 

Upon arrival to their favourite pharmacy, they hand the mystical paper to the custodians who's bravery is understated👩‍🔬. They consult among each other, sometimes review history, or have to call the prescriber for clarification. 

This waste of time, and energy is distasteful,  disrespectful and border line unprofessional.  As part of the health care team, their role is to diagnose and prescribe in a manner that simplifies therapy initiation. They believe,  however that the art of pharmacy rhymes with wizardry.  

Technology luckily has come at a time where those who cant spell or those who've forgotten how to shape their letters can now type their script and print it. This old age (mystery-filled) (mal)practice, once considered honourable and prestigious must die a prompt and permanent death.

For a prescription to be valid, it must first be legible. How do we enforce clear or printed script from here on? Policies must change and we pharmacists need to be at the forefront. ✊

www.pharmer.co.za

BPharm + Post grad? But still stuck in your career?

I often ponder and reflect on my profession.  The choices I've made and those that have been made for me. Did I freely become what I am or was I coerced into it by default?

The south African pharmaceutical industry is great but it has its structural and recruitment challenges. when it comes to entry level posts, there exists a gap between industry needs and academic skills acquired. 

 Why are there virtually no junior posts that newly qualified pharmacists can apply and get into without much fuss? I'm speaking of sub sectors. Esp when it comes to regulatory; it seems many struggle to get a fair chance let alone apply for entry level posts.

 Why are posts not calibrated in a stepwise manner? Does the grading system even work? And if it does is it being used correctly?
 In industry, 90% of vacancies seek 5+years experience and are managerial positions.  So how does one get experience? 

There also seem to be a grey area when it comes to pre-qualifications. As many candidates without the five years requirement get posts by what seems like sheer luck or connections. 

Are post graduate course ever really necessary? Many have felt like it is a waste of resources as the courses are not reflected in the positions advertised nor are they remunerated consequently. 

How does one climb the ladder from junior to senior pharmacist, and when are specific courses required and not just advantageous? It's almost as if companies dictate and set the tone and standards for their personal requirements; and appoint whomever they want in any post without much explanation nor post grad qualification correlation. 

Should legislation jump in to save the echelons?! Who can change or implement new policies concerning such problems? 

Are pharmacists fast asleep and obliviously to challenges within their own profession? Where are they and why haven't they said anything about any of this? 

Have post grad qualifications become irrelevance to most employers?  How do we begin to fix this lack of uniformity in (growth) structures and start promoting specialties (oncology, etc) and academic skills more equitably with the assurance of matched  positions and remuneration?

Moving from one sub sector in to another is also very tricky. Has the BPharm degree become inadequate and lacking specialty training? Should it be scraped off and perhaps upgraded to a more complete and respectable PharmD?! 

I'm here, thinking out loud and would love your opinions on the matter! Thanks for commenting! 

#pharmers 

Codeine Abuse: what are you doing?

Should codeine containing products be regulated? How do we curb the rampant concerns of abuse we face in our daily settings as pharmacists? 

Well this short article raises a few suggestions but many more questions. 

We've all seen the typical codeine suspect coming in to get yet another box of "codein" with a friendly smile and a ready-to-use excuse. 

It's for family, I forgot mine at home, I travelled... etc etc. 

We indulge them more often then not and advise them to only buy for themselves and not for other family members but is it enough? 

It's especially worrying when they directly request (by name) specific codeine syrups and combination flu tablets without allowing the dispenser to suggest anything else or even slightly deviate from their request! There's no telling what goes in their private homes.. do they drink the whole bottle and take multiple pills at once? 

We often see notes or alerts left by previous dispenser warning the next dispenser of a possible addiction or misuse; But when do we say NO and refuse to sell?

Should there be a form that they fill much like that of the morning after/ emergency contraception? 

Should the law change yo limit the number of purchases of pack size and frequency per month? 

Should health care professionals make a bigger effort to educate populations against the misuse of codeine and its dangers? 

If we have sugar tax and other bizzar regulations surely the state can be more stringent concerning its beloved citizens' health? 

If you had a say and a national impact how would you address the issue of codeine abuse and misuse. 

Codeine:

You work too well for your own good. 

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 www.pharmers.co.za