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Introduction of New Clinical Care Standard by ACSQHC to Address Psychotropic Medicine Use in Cognitive Disability and Impairment

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Introduction of New Clinical Care Standard by ACSQHC to Address Psychotropic Medicine Use in Cognitive Disability and Impairment

 

By Jeff Gibbs

The Australian Commission on Safety and Quality in Health Care (the Commission) has today announced the launch of a pivotal new national standard aimed at enhancing the care for individuals with cognitive disabilities or impairments. The introduction of the Psychotropic Medicines in Cognitive Disability or Impairment Clinical Care Standard is a critical advancement in promoting safer and more effective treatment protocols across the healthcare spectrum.

Background and Rationale for the New Standard

Recent decades have witnessed a 60% surge in the prescription of psychotropic medications across Australia. Despite a modest reduction in antipsychotic use among the elderly—prompted by heightened awareness of associated risks—the prescribing rates remain alarmingly high, particularly among vulnerable populations. Notably, older individuals and those residing in aged care facilities are disproportionately affected by the adverse effects of these medications, including cognitive decline, heightened risk of falls, strokes, and mortality. Additionally, approximately one-third of individuals with intellectual disabilities are prescribed psychotropic drugs, exposing them to potentially severe short and long-term side effects.

Scope and Impact of the Standard

The new Standard seeks to mitigate the inappropriate utilisation of psychotropic medications and emphasises patient safety. It priorities non-pharmacological interventions as the foremost approach for managing challenging behaviours such as aggression and agitation. Psychotropic medications are advised as a last-resort measure, following the ineffectiveness of alternative strategies or in situations posing significant risk to the individual or others.

The Standard advocates for tailored non-medication strategies that respect the individual’s needs and preferences, developed in consultation with their family and other authorised caregivers. This approach underscores the commitment to upholding the dignity and autonomy of individuals with cognitive impairments.

Expert Insights and Support

Key health experts have endorsed the significance of this new Standard. Conjoint Associate Professor Carolyn Hullick, Chief Medical Officer at the Commission, stresses the necessity for mindful prescribing practices given the limited benefits and substantial risks associated with psychotropic medications in this demographic. Professor Julian Trollor from the University of New South Wales and Juanita Breen from the University of Tasmania also highlight the importance of objective-driven prescribing, continuous monitoring, and the potential to reduce medication dosages in favour of non-pharmacological alternatives.

Implementation Across Settings

The Standard is applicable universally across various healthcare settings, including hospitals, aged care facilities, and community services, ensuring that individuals with cognitive disabilities receive consistent and coordinated care irrespective of the setting.

Professor Eddy Strivens emphasises the need for coordinated efforts and effective communication, particularly during care transitions, to maintain continuity and efficacy of treatment plans and to support decision-making processes that honour patient autonomy.

Collaborative Efforts for Enhanced Care

In a collective endeavour to address these issues, the Commission has collaborated with the Aged Care Quality and Safety Commission and the NDIS Quality and Safeguards Commission to issue a Joint Statement against the misuse of psychotropics in managing behaviours in disabled and elderly populations.

Conclusion

The introduction of the Psychotropic Medicines in Cognitive Disability or Impairment Clinical Care Standard marks a significant step forward in improving the quality of care and safety for Australians with cognitive disabilities or impairments. It aligns with ongoing efforts to reform health care, aged care, and disability support systems across the nation.

The complete Standard and accompanying resources are available on the Commission’s website here.

 

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Vape Laws Spark Opposition

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Vape Laws Spark Opposition

 

Queuing at local pharmacies is expected to become longer and more complex due to new laws permitting pharmacies to sell e-cigarettes, commonly known as vapes.

As of 1 July, pharmacies are the sole legal dispensers of nicotine-containing vapes. Initially, customers will need a prescription to purchase these products, but starting 1 October, adults will be able to buy them after a consultation with the pharmacist.

However, the new legislation has sparked significant opposition from many pharmacy chains and independent chemists. The Pharmacy Guild of Australia has strongly criticised the move, describing the expectation for pharmacists to retail vapes as “insulting.”

“Pharmacists are healthcare professionals, and community pharmacies do not want to supply this potentially harmful, highly addictive product without a prescription,” stated Anthony Tassone, the guild’s national vice-president. Tassone also emphasised that vaping products have not been approved by the Therapeutic Goods Administration (TGA) and no nicotine-containing vape is listed on the Australian Register of Therapeutic Goods.

The controversial laws were passed by Parliament following a compromise between Labor and the Greens. Beginning 1 October, pharmacists who opt to sell vapes will be able to provide them to customers aged 18 or over with proper ID but without requiring a prescription, as nicotine vapes will be reclassified from schedule 4 to schedule 3 of the poison’s standard. However, individuals under 18 will still need a prescription to purchase nicotine vapes.

The intent behind the new laws is to regulate the sale of nicotine vapes more strictly while making them accessible for adults who choose to use them. Despite this, the Pharmacy Guild remains critical, highlighting the health risks associated with vaping and the added responsibility placed on pharmacists to manage these products safely.

As the implementation date approaches, the debate within the healthcare community and among the public is likely to intensify, raising questions about the balance between accessibility and safety in the regulation of nicotine vapes.

 

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Onsite Pharmacists – Just What the Doctor Ordered

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Onsite Pharmacists
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Onsite Pharmacists – Just What the Doctor Ordered

 

The Aged Care Onsite Pharmacist (ACOP) program aims to revolutionise medication delivery in residential facilities by placing trained professionals directly on-site.

Addressing Medication Mismanagement

The mismanagement of medications, inconsistent safety procedures, and low vaccination rates in aged care homes have long been controversial. Health authorities are urging providers to increase vaccine rates, as the lives of residents and communities are at risk. Despite these pleas, the Royal Australian College of General Practitioners reported that 97 aged care facilities had COVID-19 vaccination rates below 10%. Additionally, 706 facilities reported less than 50% of their residents vaccinated against COVID, with the lowest coverage in various states including New South Wales, Queensland, South Australia, Tasmania, Victoria, and Western Australia.

The Role of Onsite Pharmacists

The Aged Care Royal Commission identified medication delivery as a crucial area for improvement in aged care homes, recommending the employment of allied health practitioners, including pharmacists. Responding to this, the Federal Government has allocated $333.7 million to fund the ACOP program. This initiative enables residential aged care providers to engage pharmacists through local pharmacies or direct employment. These pharmacists will deliver personalised medications, manage frequent medication reviews, and administer antipsychotic drugs and vaccinations.

Goals of the ACOP Program

The ACOP aims to:

  • Improve medication use and safety in aged care homes, particularly the use of high-risk medications.
  • Ensure continuity in medication management through regular reviews and prompt issue resolution.
  • Provide easy access to pharmaceutical advice for residents and staff.
  • Integrate on-site pharmacists with the healthcare team, including local GPs, nurses, and community pharmacies.
  • Enhance understanding and response to individual resident needs.

Support from the Pharmacy Guild of Australia

The initiative has garnered support from the Pharmacy Guild of Australia, recognising the potential to elevate the role of pharmacies. This program enables pharmacists not only to deliver medications and dose administration aids but also to provide quality use of medicines within the facility. A Pharmacy Guild spokesperson highlighted the additional services pharmacists can offer, such as vaccinations, as they begin to practice to their full scope. This will create further opportunities for community pharmacies to become significant providers of healthcare services to aged care facilities.

Funding Model

The ACOP funding model is divided into two tiers:

  • Tier 1: Community pharmacies receive payments to engage with specific residential aged care facilities.
  • Tier 2: Residential aged care facilities can claim up to $138,282 per year for the full-time equivalent employment of an on-site pharmacist.

This government-funded initiative promises to improve medication management and overall healthcare in aged care facilities, ensuring better health outcomes for residents.

 

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Foods That Can Help Reduce or Prevent Joint Pain

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Minimally processed, whole foods That Can Help Reduce or Prevent Joint Pain
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Foods That Can Help Reduce or Prevent Joint Pain

 

Minimally processed, whole foods — including brightly coloured fruits and vegetables, healthy fats, and lean proteins — may help relieve inflammation and other symptoms that lead to joint pain. Inflammation is a common cause of joint pain, often associated with arthritis and other joint conditions. Eating foods that help reduce inflammation may improve joint pain and offer additional health benefits, such as improved heart health.

Can Diet Help Reduce Joint Pain?

Research indicates that diet can significantly impact joint health. A survey of 217 people with rheumatoid arthritis (RA) found that 24% reported their diet affected their symptoms. A 2023 study on osteoarthritis supports the idea that certain diet patterns can improve joint symptoms. Diets high in nuts, legumes, fruits, vegetables, and seafood, which contain anti-inflammatory properties like antioxidants and phytochemicals, may help reduce joint pain.

Beneficial Foods for Joint Pain

Incorporating anti-inflammatory foods into your diet can help reduce joint pain and slow disease activity. Beneficial foods include:

  • Nuts: Rich in healthy fats and antioxidants.
  • Legumes: High in fibre and protein, reducing inflammation.
  • Fruits and Vegetables: Packed with vitamins, minerals, and antioxidants.
  • Seafood: Especially fatty fish like salmon and mackerel, high in omega-3 fatty acids.

Foods to Avoid

To manage joint pain, limit or avoid processed foods, trans fats, and added sugars. A nutrient-rich diet can also help maintain a moderate weight, reducing strain on the joints.

Popular Diets for Joint Pain

The Mediterranean Diet

Emphasises fruits, vegetables, whole grains, legumes, and healthy fats, with moderate seafood and poultry, and limited dairy and red meat. Associated with reduced inflammation and improved joint health.

The DASH Diet

Includes fruits, vegetables, fish, poultry, nuts, whole grains, and low-fat dairy while restricting salt, sugar, fats, and red meat. May help improve and reduce the risk of gout, a type of arthritis that causes joint pain.

Conclusion

Incorporating a variety of nutrient-rich, anti-inflammatory foods into your diet can help manage and prevent joint pain. Following dietary patterns like the Mediterranean or DASH diets may offer comprehensive benefits for joint health and overall well-being.

 

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