Queensland Vaccinations – Trial and tribulations
Pharmacists and vaccines have been two prominent themes in the Therapeutics Committee’s work over the last few weeks.
The AMA has opposed a trial by the Queensland Health Department of community pharmacists providing influenza vaccinations because the trial will proceed before pharmacists receive accredited training to perform safe and effective vaccinations – and the details of the training are still unknown. Similarly, AMA NT has raised concerns about recently introduced State legislation that will allow pharmacists and other non-medical health practitioners to immunise patients.
The Pharmacy Board of Australia stated in a communique on 5 December 2013 that work on competencies and training is required before vaccination by a pharmacist is able to occur. This means that competencies and standards must first be established; then training programs developed and accredited; and the Board must approve programs of study and set a registration standard for endorsement for scheduled medicines.
AMA Queensland President Dr Christian Rowan and I wrote to the Queensland Chief Health Officer in January about the AMA’s concerns. Dr Young replied that pharmacists in the trial will undertake training in CPR, first aid, and the recognition and emergency management of anaphylaxis. I have since written to the Pharmacy Board of Australia asking whether it considers pharmacists participating in the trial will be practising outside their scope of practice and without completing an accredited education and training program approved by the Board. I am awaiting a response.
Still on the theme of vaccinations, several medicine sponsors have been lobbying the AMA to support submissions they have made to the Pharmaceutical Benefits Advisory Committee (PBAC) to be considered at its meeting in March.
The sponsor of the shingles vaccine, Zostavax, is one of these pharmaceutical companies. Zostavax was recommended by PBAC for subsidy under the National Immunisation Program some five years ago but issues with supply meant that it did not proceed.
The arguments for and against Government subsidy of a medicine are always complex. PBAC has a difficult task in assessing cost effectiveness as well as comparative effectiveness. The AMA takes the position that PBAC, as an independent body of experts, should be supported to make its recommendations without the interference of government or the influence of specific interest groups.
We are interested in engaging with the pharmaceutical industry to learn about new medicines but we do not advocate for pharmaceutical companies or a particular brand or product.
For this reason, we are also leaving the TGA and PBAC to determine how they wish to respond to a bid by OxyContin’s sponsor to have the new ‘difficult-to-crush’ form of this drug, which makes it less prone to misuse, either recognised as a new drug with a new patent period, or to require any generic version of OxyContin to mimic the ‘hard-to-crush’ characteristic.
Back to the theme of pharmacists, the Department of Health and the Pharmacy Guild of Australia announced changes to the Home Medicines Review (HMR) program from 1 March, including a cap of 20 per month for each service provider and a timeframe of 24 months between repeat or additional HMRs for each patient. It appears that without the cap, the funding for HMRs under the current Community Pharmacy Agreement would either run out before the end of the Agreement or money would have to be taken from another patient program to fund it.
In the lead up to the 2015 Community Pharmacy Agreement negotiations, the AMA will keep a watch on how the cap impacts on general practitioners and patient care. The AMA is also represented by Dr Richard Kidd on an advisory panel, which is overseeing a research project conducted by the Guild on HMR patient eligibility criteria. The findings of this project and the broader review of the medicines management component of the Agreement will inform how these programs are managed in the future.
You can let me know of any negative impact on your patients from the HMR caps by emailing firstname.lastname@example.org