Medicines and heatwaves – RGH Pharmacy E-Bulletin

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Global climate change continues to be the subject of international debate, which has included concern about the health impacts of climate change. Attention has also focused on the impact of ‘heat waves’ on morbidity and mortality.

Over 70,000 additional deaths were recorded in 12 European countries over the summer of 2003 during a prolonged heatwave – after this, a number of related papers were published in medical literature, including some that specifically looked at the potential for increased harm from medicine use during the heatwaves.

A number of countries including Australia have since operationalised ‘National Heat Wave Plans.’ In Australia individual states having developed specific information for to help people to manage in heatwaves, including SA Health’s “Extreme Heat – guide to coping and staying healthy in the heat.”

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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.

Medication Safety in Pregnancy: RGH E-Bulletin

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In pregnancy, the use of medications (both prescription & over-the-counter) is often managed with great caution. The issue can be compounded by an increased need for medications, as pregnant women can be affected by ailments such as constipation, haemorrhoids, nausea, nasal congestion, heartburn, hypertension, oedema, and an amplification in general aches and pains.

An increased risk of birth defects or miscarriage caused by drugs is a common concern for both parentsto-be and practitioners involved in their care. As such, information surrounding safety of drugs is paramount in minimising potential drug-induced harm to a pregnancy.

Read the complete bulletin:

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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.

Practical Pharmacy: Stock Control

Lately I seem to have become a bit of a file linker and server. But many of the smaller specialised newsletters I find worthwhile and wish to share either don’t have a home on the web or are only put up quite some time later. The Victorian Residential Aged Care Coronial Communique is a case in point.

Another specialised newsletter is the HAI Africa Practical Pharmacy Newsletter. Again the current edition is not on the web. Previous editions can be found here. Click on the picture to download the current issue 7MB)

click on picture for newsletter

This newsletter is designed to help train indigenous workers in Africa about all things pharmacy. The current edition focuses on the basic building block of logistics. Stock Control.

It covers everything from ordering to stock management and expired drug disposal. In remote Australia we can receive medications regularly by plane and no cost but many of these principles we still use in our clinics.

A Wander Through Chronic Disease and Indigenous Health

In 2004-05 two surveys were undertaken by the Australian Bureau of Statistics to enable comparisons between the health of Indigenous Australians and non-Indigenous Australians.

The survey showed that approximately 6% of indigenous Australians reported either having diabetes or High Sugar Levels (HSL). Indigenous people living in the towns and cities of Australia had close to half the incidence of diabetes or HSL than those indigenous Australians living in remote Australia (5% compared to 9%).

But how does the incidence of diabetes in Aboriginal and Torres Strait Islanders compare to the rest of Australia?

This is not a trick question.

The answer of course is “pretty poorly”. Overall Australia’s Indigenous population was three times more likely to have diabetes than the non-Indigenous population. But it was much worse depending on where you live.

Indigenous people living in remote areas of Australia were more than eight times more likely to report having diabetes or HSL than non-Indigenous people.

In remote areas, Indigenous females were fourteen times as likely to have diabetes or HSL as non-Indigenous females. Indigenous males were nearly six times as likely to have diabetes or HSL as non-Indigenous males living in remote areas.

Diabetes & HSL rates by Indigenous status 2004-05

Diabetes & HSL rates by Indigenous status 2004-05

There is a little, well, rather a big project underway in Australia analysing HbA1c data by postcode for five years.

The “Mapping Glycaemic Control Across Australia Project” will collect, clean and analyse the HbA1c data annually for the next five years. Annual updated summary data will be made available for access through the Changing Diabetes Map providing a framework to track and monitor HbA1c levels.

For the lay person reading this – the HbA1c is a measure of the amount of “sugar” in our red blood cells. As red blood cells last in our our body and are replaced in theory every three months or so it gives us a good picture of the last three months. The project states Australia’s average HbA1c is 7.6%. A well controlled diabetic would aim to have a HbA1c below 7%.

hba1c

The map searches by postcode. Except for remote areas that is. Then it uses huge geographic regions not allowing us to see HbA1c averages in remote Indigenous areas. It does show the increasing HbA1c levels generally seen in remote and rural areas compared to more urban areas.

A recent news article stated Indigenous Australians have ten times (10x) the incidence of renal disease than other Australians (The same article quoted the figures that Native Americans have double the incidence of end-stage renal disease, and in Canadian Indians the incidence is two and a half times greater, compared with non-indigenous North Americans.)

Now I don’t have a breakdown for renal disease for remote areas compared to non-remote areas as I do for diabetes. But with these much higher levels of disease you would expect healthcare and pharmaceutical costs to be through the roof compared to other Australians.

Sit down for a little surprise.

There is a lovely little report titled ‘Expenditures on health for Aboriginal and Torres Strait Islander peoples 2004-05‘. Note it covers the same period as the ABS diabetes statistics.

Renal disease at ten times the incidence, diabetes (in remote areas) at eight times higher incidence yet the higher spend on healthcare for indigenous Australians was pitiful, especially when you look at the cost of providing healthcare in remote areas.

In 2004-05, $1.17 per person was spent on Aboriginal and Torres Strait Islander health for every $1.00 spent on the health of non-Indigenous Australians. Average total health expenditure per Aboriginal and Torres Strait Islander was $4,718 compared with $4,019 per person estimated for non Indigenous Australians.

The pharmaceutical spend was deplorable. The average expenditure on pharmaceuticals for Australia’s Indigenous population in 2004-05 was 40% of what Australia as a whole spent per individual (PBS subsidy). $140 spent per Indigenous Australian compared with $273 for each non-indigenous Australian.

In remote areas medications are provided by what is called the S100 scheme. This gives us dollar values of what was shipped to remote clinics. Not necessarily what was used by patients. The government figures state that remote Indigenous Australians use $186 of Pharmaceutical Benefit Scheme medications per head. This figure is pathetic considering the incidence of these chronic diseases.

But this Amount of $186 per remote Indigenous person overstates the amount of medications used to treat chronic diseases.

This figure is the value of PBS medications shipped to clinics, not what is used on patients. Some clinics have massive waste due to not having ordering systems in place. And you do need to run with a slight excess and carry some emergency drugs that may go out of date (eg Reteplase at over $1000).

Remote clinics also handle the acute presentations that in urban areas are looked after by hospitals. While these items are not expensive large numbers are used. Benzathine Penicillin, Normal Saline bags for IV use, Ceftriaxone and other parenteral antibiotics in numbers you would not see being dispensed by your normal pharmacy on the PBS. There is no where near $186 dollars per head being spent in providing medications to treat chronic disease in remote Australia.

So what have we got. Massive incidences of chronic diseases in our Indigenous population compared to the rest of us. Despite chronic disease many higher in Indigenous Australians than other Australians there is overall only 17% increased health spending and well under half the usage of medications required to adequately treat these diseases.

Looking at those figures it will come as no surprise that the same report states hospital separations for Indigenous Australians in remote and very remote areas are 820 and 606 per 1000 people respectively.

Is it just me or is there something quite wrong in all this?

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