ipu review, june 2014

New IPU President takes office

IPUReviewIreland’s Official Pharmacy Publication

HMR Ireland – a new business

intelligence service

Overview of IPU Conference 2014

JUNE 2014

Buying & Selling Now | CPD: Ankylosing Spondylitis | Staff training & mistake making

IPU Group Home

Insurance

Is suitable for Adults, Children & Infants

Don’t letdiarrhoea spoil

your holiday

€750of holiday

vouchers to be won*

*Consumer competition, buy Tasectan and be in with a chance to win a €500 holiday voucher. Pharmacy with the winning entry wins a €250 holiday voucher. Competition runs from 1st May - 31st July 2014. For competition POS contact Ocean Healthcare 01 2968080.

Tasectan is available from Ocean Healthcare & all Wholesalers.

NOW ON TV

Now sponsoringthe weatheron TV3 & 3E

MOC2690Tasectan summer holiday trade_ad_A4.indd 1 23/04/2014 10:41

45

Front Cover: IPU President, Kathy Maher and Minister of State for Health, Alex White T.D. at the Annual IPU Conference in Cavan.

The IPU Review is published monthly and circulated to Irish pharmacists. The views expressed by contributors are not those of the IPU nor is responsibility accepted for claims in articles or advertisements.

Subscription:€85 (Ireland North & South) and €130 (including postage overseas).

Publisher: Irish Pharmacy Union (IPU Services Ltd), Butterfield House, Butterfield Avenue, Rathfarnham, Dublin 14Tel: (01) 493 6401 Fax: (01) 493 6626 Email: [email protected]: www.ipu.ie

Editor: Jack Shanahan MPSI Editorial Associates: Jim Curran, Wendy McGlashan and Aoibheann Ní Shúilleabháin Advertising: Wendy McGlashan Email: [email protected] Tel: (01) 493 6401 ©2014 Copyright: All Rights Reserved, Irish Pharmacy Union. Printed by Ryson Colour Printers Ltd.IPU Review is a Registered Trademark of the Irish Pharmacy Union.

JUNE 2014Contents

IPU REVIEW

18

05 A Note from the Editor

Cover Story10 Interview with Kathy Maher The IPU’s new President talks about facing the next two years’ challenges

IPU News The latest news and events from Butterfield House06 New IPU Officers06 Irish pharmacy flu vaccination services highlighted at global level06 eLearning available for IPU Academy courses08 Pharmacy Retail Sales Course08 IPU/ILM Diploma in Leadership & Management

Features13 Turning on your data to maximise your business potential

A new business intelligence service 18 An overview of the IPU National Pharmacy Conference24 CPD: A community pharmacy anticoagulant clinic30 CPD: Advances in Ankylosing Spondylitis management34 Migrant women

Their sexual health issues36 MediStori – a new medicine management system40 Now & Next: Buying & Selling Now43 Are your customers “raving” about your customer service?45 IPU Group Home Insurance46 Investment funds outperform deposits48 Staff training and mistake making50 Political Report IPU

All the latest pharmacy news from the Houses of the Oireachtas52 Professional Studies54 The Exhibition Hall at the IPU Conference

News58 International Pharmacy News – What’s happening abroad59 National Bowel Screening Programme59 AMD Aware – the new smartphone app 60 HIQA guidance aimed at reducing medication errors61 Product Information63 Classified Ads

IPUSERVICESLTD

10

40

34IPUREVIEW JUNE 2014 3

Buy better with Link!

Our members are currently availing of fantastic benefits including;• Twice daily deliveries • Dedicated representatives & telesales team

• Orders accepted in units & cases • Wholesaling reputable & trusted brands

• Compelling monthly special offers • POS kits to support monthly offers

• No minimum order value • Daily communications via our website

Offers shown expire on May 31st 2014.

Visit www.uniphar.ieor call 01 468 7501

A4-LINK-IPU_ad.qxp_Layout 1 16/05/2014 17:02 Page 1

Recent events have brought the Council of the Pharmacy Regulator into sharp focus. The President, Vice President and another member submitted their resignations within a short period. All three are community pharmacist and all three are highly regarded in the profession. Their experience and counsel will be missed. In each case they were elected by open ballot by their colleagues. At the risk of offending Oscar Wilde’s character, Lady Bracknell, to lose one Council member is unfortunate, to lose three sounds like pure carelessness.

Striking the right balance

To be elected, or as the Act specifies, selected, as a pharmacist to the Council of

the PSI is, currently, a great honour. The individuals that do this are seen as people of integrity, in whose judgement and experience the profession has vested confidence. They have committed themselves to an enormous burden of voluntary work. It is important to understand that, currently, the pharmacist on Council is not viewed as having a representative role, in that elected Council members are not regarded as the pharmacy equivalent of a TD. Their primary role is to act as a responsible individual who will act in the interests of the public. Yet, there is an inherent duality of roles, the practitioner and the public interest, vested in the position. Any pharmacist, regardless of which area they practise, is expected to bring their experience, judgement and professional views to bear in the decisions they make at Council. It is why they are there.

The Pharmacy Act of 2007 is clear: there is a permanent secretariat, consisting of highly qualified and competent professionals, headed up by the Registrar. Overseeing this function is the Council of the PSI, which

consists of 21 members. Nine of these are pharmacists, selected by pharmacists on the register, the profession. The tenth is a pharmacist nominee of the pharmacy educational bodies. The Act specifically states that the other eleven members cannot be, or ever have been, pharmacists. Some have specific representative roles, like those from the IMB and the HSE. The legislative intention was and is, clear. The role of the PSI is specific, defined in Section 7 of the Act. While all members of the Council are appointed by the Minister, the Act specifically denies him the ability to veto the selected elected pharmacists. This is a sensible balance, giving the elected members a degree of freedom from political interference.

The recent resignations and turbulence on the Council have brought a slew of rumour and conjecture. It would be reasonable to say that passions have run high, particularly in the absence of solid facts. It is important to step back and take a broader perspective. Some very obvious questions arise. Bearing in mind what was written above, what is the expected function of the elected pharmacists? Should some, or all, have a more obvious representative role? Is it possible to strike

the right balance between representation and the public interest? Obviously the legislators felt that the HSE and the IMB could do it. It would be invidious to suggest that pharmacists could not.

Public safety and protection is at the core of the PSI regulatory function. This is incontrovertible; the only real question is the method of achieving this. Regulation creates natural tensions between the regulator and the regulated. This is normal. Most pharmacists can get justly infuriated over what is seen as pedantry. Appropriate regulation can distinguish between the important and box ticking. The regulation of the profession is still at the early stages. Lessons must be learned, mistakes will be made. There is a perception that there is an over reliance on the letter of the law and not enough on the spirit. The balance will be struck eventually. Yet, we should not lose sight of the essential requirement of a properly functioning community pharmacy sector. As the profession continues its evolution, it is vital that standards are kept high. If the overarching concern of community pharmacy becomes solely bottom line driven, there will be only one outcome. The public and the profession deserve better.

A NOTE FROM THE EDITOR Jack Shanahan, MPSIBuy better with Link!

Our members are currently availing of fantastic benefits including;• Twice daily deliveries • Dedicated representatives & telesales team

• Orders accepted in units & cases • Wholesaling reputable & trusted brands

• Compelling monthly special offers • POS kits to support monthly offers

• No minimum order value • Daily communications via our website

Offers shown expire on May 31st 2014.

Visit www.uniphar.ieor call 01 468 7501

A4-LINK-IPU_ad.qxp_Layout 1 16/05/2014 17:02 Page 1

IPUREVIEW JUNE 2014 5

IPU NEWS

Irish pharmacy flu vaccination services highlighted at global level The flu vaccination service provided by pharmacies in Ireland was cited as a huge success and a great example of the value of pharmacists in immunisation at the 67th WHO World Health Assembly on 21 May.

Pointing out the growing evidence that pharmacists improve vaccination coverage for groups that other healthcare professionals find hard to reach, the International Pharmaceutical Federation (FIP), drew attention to research showing that over a quarter of patients (28%) vaccinated in pharmacies in Ireland had never had an influenza vaccination before and 81% of those patients were in an at-risk category.

The statistics that formed the basis of this research were from IPU NET, which highlights the importance of this tool for pharmacists when deliverig and recording services to patients.

The success of the Irish service was highlighted by FIP during a discussion of the

World Health Organisation’s global vaccine action plan. In the ‘Joint WHO-FIP guidelines on good pharmacy practice’, WHO and FIP emphasised that pharmacists should be used to their full potential in educating about safety and relevance of immunisation, and facilitating or providing vaccination.

Commenting, IPU President Kathy Maher said, “The introduction of the flu vaccination service in Irish pharmacies has been a huge success with the number of vaccinations provided in community pharmacy quadrupling in the last two seasons. The success of the service confirms that pharmacists have a vital role to play in implementing and delivering additional services that benefit the patient and the healthcare system. This international recognition demonstrates the value of expanding the role of pharmacists as an essential part of the reform of the delivery of healthcare services.”

New IPU Officers appointed at recent AGM

Pictured at the 4th annual IPU National Pharmacy Conference were (L-R) Honorary Treasurer Bernard Duggan, Vice President Daragh Connolly and President Kathy Maher with Secretary General Darragh O’Loughlin. The IPU Officers for 2014-2016 were elected by the Executive Committee at their April meeting and took up office following the AGM on Sunday 11 May.

An electronic version of each of the topics presented in the IPU Academy Spring Programme is now available on www.ipuacademy.ie. This is to facilitate those of you who were unable to attend the live courses during the Spring Programme.

Log on to www.ipuacademy.ie and use your personal membership log-in to complete an eLearning version of the following topics:

1. Paediatrics.

2. An Update on the Management of Pain.

3. The Management of Chronic Obstructive Pulmonary Disease (COPD).

4. A Review of Insulin Therapy.

5. Emerging Technologies: Monoclonal Antibody Based Pharmacotherapy.

This eLearning format allows you, as a member of IPU Academy, to engage with Continuing Education at a time that is convenient to you and removes the need to travel to attend a course.

eLearning now available for IPU Academy Spring Programme courses

IPUREVIEW JUNE 20146

Teva delivers on what is important to Pharmacyincluding a Transparent Pricing Model, Continuity

of Supply and Dedicated Customer Service

† IMS units, Qtr Feb 14 and MAT Feb 14.

BOX CLEVER WITH TEVA

Teva Pharmaceuticals Ireland, Building 1, Finnabair Business Park, Dundalk, Co. Louth, Ireland.

Ireland's leading supplier of prescription medicines†No1IrelandTeva Pharmaceuticals Ireland

IE/G

EN/1

3/00

05e

Dat

e of

pre

para

tion:

May

201

4

C

M

Y

CM

MY

CY

CMY

K

Race Teva FA.pdf 1 22/05/2014 14:39

IPU/ILM Diploma in Leadership and ManagementA new semester for the IPU/ILM Diploma in Leadership and Management is commencing in September. This fully accredited Diploma course will focus on Leadership and Management styles and will assist the candidate in being confident as both a leader and manager of a team within their work place. For information on course content, delivery, assessment, progression and cost, see pages 38 and 39.

Pharmacy Retail Sales CourseThe Pharmacy Retail Course is commencing on 5 October. This course is specifically tailored for both the experienced sales team member wanting to refresh their skills and to assist the new sales team member in developing their sales ability and gaining essential knowledge. This blended learning course is delivered online over eight weeks with one face-to-face induction workshop. For further information, please visit www.ipu.ie > Training & HR > Pharmacy Retail Sales Course.

Pharmacy in the mediaThe Quarterly Retail Trends Survey received media coverage at the beginning of May, with Daragh Connolly quoted in national media and in online media, Business and Leadership.

There was significant national media coverage following the IPU National Pharmacy Conference. A number of press releases were issued to the media and covered topics such as a call for exemption of patients to the prescription levy, the hardship caused by the widespread withdrawal of medical cards, the availability of more medicines without prescription and the ability of pharmacists to alleviate pressure in the health service.

Key results from an IPU survey carried out by Behaviour & Attitudes (B&A) were also covered in a statement, which showed that 71% of respondents are “strongly in favour” of pharmacists being able to provide services to improve patient adherence to medicines. The public opinion survey also reported that 70% are “strongly in favour” of pharmacists being allowed to prescribe some medicines for minor ailments.

The B&A survey also highlighted that 38% of medical card patients said that the increase in the prescription levy would make them “think twice” about filling a prescription. The IPU called on the Government to introduce an exemption for vulnerable patients, including those who are homeless, those with intellectual difficulties or in palliative care and those in residential care settings.

IMB Chief Executive Pat O’Mahony’s announcement regarding switching medicines from prescription only status to pharmacy only received a large amount of media coverage. IPU President Kathy Maher welcomed the move saying, “we have long argued that too many medicines are prescription only and that pharmacists should be empowered to have greater discretion in deciding whether to dispense medicines to patients. This is key to improving public access to medicines in a safe environment.”

We also highlighted the disgraceful behaviour of the withdrawal of medical cards from patients who are in desperate need of them. Darragh O’Loughlin commented that pharmacists have reported seeing increasing numbers of patients who have had cards withdrawn in recent months. “Cards are being withdrawn from patients including very vulnerable patients on an indiscriminate basis. This is causing real hardship for patients who are utterly dependent on their medical cards and who are finding that the cards are being withdrawn without notice or explanation. Patients with long term illnesses such as diabetes are left extremely worried about how they are going to access essential and often lifesaving treatment such as insulin,” he said.

Media coverage was received in the Irish Times, Irish Independent, Irish Examiner, Irish Daily Mail, Irish Daily Mirror and the Sun. Online media coverage included the Journal.ie and Irishhealth.com websites.

Darragh O’Loughlin was interviewed on RTE One’s The Consumer Show discussing the price of medicines in Ireland and the Healthwave business model.

Dates for

your Diary

June is Sunsmart – International

Men’s Health Month

5 June Haemochromatosis

Awareness Day

9-15 June National Carers Week

9-15 June Men’s Health Week

14 June World Blood Donor Day

IPU NEWS


A new LAMA for the treatment of COPD1

Improvement in early morning, daily and night-time COPD symptoms.2

Twice daily administration2

NEW

Date of Item: Feb 2014 14Eklira006

Eklira Genuair 322 micrograms inhalation powderAbbreviated Prescribing Information Please consult the Summary of Product Characteristics (SPC) for the full prescribing information. Presentation: Inhalation powder in a white inhaler with an integral dose indicator and a green dosage button. Each delivered dose contains 375 µg aclidinium bromide equivalent to 322 µg of aclidinium. Also, contains lactose. Use: Maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD). Dosage: For inhalation use. Recommended dose is one inhalation of 322 µg aclidinium twice daily. Patients should be instructed on how to administer the product correctly. No dose adjustments are required for elderly patients, or those with renal or hepatic impairment. No relevant use in children and adolescents. Contraindications: Hypersensitivity to aclidinium bromide, atropine or its derivatives, including ipratropium, oxitropium or tiotropium, or to any of the excipients. Warnings and Precautions: Do not use in asthma. Stop use if paradoxical bronchospasm occurs and consider other treatments. Do not use for the relief of acute episodes of bronchospasm. Use with caution in patients with myocardial infarction in the previous 6 months, unstable angina, newly diagnosed arrhythmia within the previous 3 months, or hospitalisation within the previous 12 months for heart failure functional classes III and IV. Dry mouth, observed with anticholinergic treatment, may be associated with dental caries in the long term. Use with caution in patients with symptomatic prostatic hyperplasia or bladder-neck obstruction or with narrow-angle glaucoma. Do not use in patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption. Interactions: Do not administer with other anticholinergic-containing medicinal products. No other interactions expected. Please consult the SPC for more details. Fertility, pregnancy and lactation: No data on use in pregnancy. Consider risk-benefit before using during lactation. Unlikely to affect fertility at the recommended dose. Side-effects: Common (1-10%): Sinusitis, nasopharyngitis, headache, cough, diarrhoea. Uncommon (0.1- 1%): Blurred vision, tachycardia, dysphonia, dry mouth, urinary retention. Pack sizes: Carton containing 1 inhaler with 60 unit doses. Legal category: POM Marketing Authorisation Number: EU/1/12/778/002 Marketing Authorisation holder: Almirall, S.A., Ronda General Mitre 151, ES-08022, Barcelona, Spain. Marketed by: A. Menarini Pharmaceuticals Ireland Ltd., Castlecourt, Monkstown Farm, Monkstown, Glenageary, Co. Dublin. Further information is available on request to A. Menarini Pharmaceuticals Ireland Ltd. or may be found in the SPC. Last updated: March 2014.

References: 1. Kerwin EM, D’Urzo AD, Gelb AF, et al. Efficacy and safety of a 12-week treatment with twice-daily aclidinium bromide in COPD patients (ACCORD COPD I). COPD. 2012;9(2):90-101. 2. Eklira® Genuair® Summary of Product Characteristics, last updated January 2014.

This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions to:

IMB Pharmacovigilance, Earlsfort Centre, Earlsfort Terrace, IRL - Dublin 2. Tel: +353 1 6764971, Fax: +353 1 6762517, Website: www.imb.ie, e-mail: [email protected]

Adverse events should also be reported to A. Menarini Pharmaceuticals Ireland Ltd. Phone no: 01 284 6744.

Eklira A4 Advert Updated.indd 1 13/05/2014 13:34

Newly elected IPU President Kathy Maher talks about the next two years

INTERVIEW

Tell us about your background.

I am originally from Lurgan in Co Armagh and moved to Belfast to study pharmacy in Queen’s University Belfast. I graduated in 1996, did my pre registration year with McKeagney Chemists in Lurgan and registered with the Pharmaceutical Society of Northern Ireland in July 1997. This was followed by a move to the Republic of Ireland later that year, registering with the

PSI. After working in north Co Dublin for several years, I went to locum in Duleek Pharmacy, Co Meath, in 2000. I ended up staying there and bought that pharmacy with my husband Tom (also a pharmacist) in 2005. I continued to study, completing a postgraduate Diploma in Community Pharmacy and a Diploma in Diabetes Management in Primary Care. I was a tutor with the ICCPE for many years.

How did you get involved with the IPU?

I am passionate about pharmacy and the patients that we care for so I was always very keen to become involved in the direction my profession was taking, especially when seeing the changes and challenges that colleagues were faced with in other jurisdictions, particularly in the UK. I contacted the IPU when I was an employee

and became active in the Employee Group at that stage. I have served on all of the committees of the IPU.

Why did you put yourself forward for the position of IPU President?

After serving as Honorary Treasurer for two years, I made the decision in 2012 to put myself forward for the position as Vice-President with Rory O’Donnell as


President. I gained a really good understanding of the strategic and political environment in which pharmacy operates, the priorities of various stakeholders with whom we interact and the challenges we face. After making the necessary changes to enable myself to commit to the role, I decided to put myself forward for President when Rory’s term was complete. I feel that I have the drive and determination to face the challenges our profession faces over the next two years but also the vision and energy to look for innovative solutions. I look forward to steering the profession and the organisation through these challenging times with enthusiasm and relish.

What, in your opinion, are the main challenges facing the pharmacy sector over the next two years?

Reference Pricing will remain a significant challenge to the profession as the cost of medicines continues to reduce and the availability of some medicines will continue to be problematic. We need to see greater cooperation with all stakeholders to ensure that pharmacists can provide the necessary medicines to their patients in a timely fashion, without supply interruptions. Also, we need a fairer and more transparent system of reimbursement so that pharmacy contractors can be sure that the services they have provided, in good faith, are paid on time and appropriately. We need to bring a sense of financial certainty to the sector to

avoid seeing further declines in services and more job losses.

The 2007 Pharmacy Act and developments such as the Irish Institute of Pharmacy have the potential to enhance the professional standing of Pharmacy in Ireland. It is vital, however, to ensure that the implementation does not place unreasonable, expensive, impossible burdens on pharmacists. I believe that we can survive these challenges, but we need to pull together. Community pharmacists working together will not only meet these challenges, but overcome them and, in turn, create opportunities along the way.

What do you see as the challenges facing the IPU?

The IPU office in Butterfield House is a hub of dedicated people working for the profession of pharmacy. The staff do often unseen work on behalf of pharmacy and us as individual pharmacists. The IPU belongs to its members and its policies are determined by its elected representatives. In these tougher times, we tend to look inwards on our businesses and I would urge pharmacists to reach to the IPU for support and guidance. Without our members, there is no IPU. The IPU is the voice of community pharmacy and I would ask all pharmacists to engage and communicate with the IPU and all elected representatives, regional and national, to keep us at the forefront of leading this profession.

In a changing healthcare system, where do you see the role of pharmacy?

Pharmacy is pivotal in the rollout of a successful healthcare system. As community pharmacists we know that pharmacy is the most accessible and visited of all healthcare settings. We know that we’ve responded to challenges and have evolved to improve health outcomes. The extremely successful Seasonal Flu Vaccination Service introduced in 2011 clearly demonstrates that not only does the pharmacy sector rise to the challenge but we take it to another level.

We need a greater degree of joined-up thinking and a much greater degree of involvement and partnership with other healthcare professionals. Primary care is cited as the most efficient setting for the vast majority of healthcare needs of the public. We need decision makers to put words into action and expand the role of the pharmacist, which will improve health outcomes and cost savings to the State. With an ageing population and increased levels of chronic disease, pharmacists can offer additional services to lift the strain in the health service by treating patients in their community. We have heard about treating patients at the ‘lowest level of complexity’ for some time and now is the time to put this to work.

I would like to see a system of seamless healthcare, without duplication, with greater patient adherence to medicine and a better acceptance and recognition of pharmacy’s vital role in bringing this about.

How will you judge if your term in office has been successful?

Within the next two years I would like to see a far greater range of medicines available without prescription so that pharmacists can use their clinical skills to counsel and treat patients appropriately with more medicines available to them. The IPU has been calling for this for many years and, while we have light at the end of the tunnel, we need these changes to happen in a timely manner, to improve access to patients.

I would hope for real and substantive change in extending the role of the pharmacist, with many services that could be rolled out quickly, safely and effectively to benefit the patients of this country. International evidence has shown that extending the role of the pharmacist will result in fewer visits to A & E, less hospital readmission, less GP visits and a reduction in morbidity. I want to do all in my power to help ensure this happens, and hope to look back in two years’ time with satisfaction that we are on the way, if not there already.

Away from the heavy schedule of running a pharmacy and fulfilling the role of IPU President, what do you do to unwind, relax?

I love to relax by doing nothing else other than being at home with Tom and our three children, daughters aged eight and six, son aged three, and having friends over to chill out with nice food and wine. To de-stress I go for a short run on the country roads – silence!

“ The IPU belongs to its members and its policies are determined by its elected representatives. In these tougher times, we tend to look inwards on our businesses and I would urge pharmacists to reach to the IPU for support and guidance.”


Get in touch with your

allergy

Year round relief

Always read the label carefully and please ask your pharmacist for further details.Reference: 1. IMS Data July 2013 ROI Cetirizine and Pseudoephedrine Preparations

September 2013 Code: UK/12ZI0011aDate of Preparation:

Relief from sneezing, itchy, runny or blocked up nose associated with allergies

Available in Pharmacies Nationwide

Zirtek Plus Decongestant 5mg/120mg Prolonged Release Tablet

Ireland’s best seller1

pseudoephedrine hydrochloridecetirizine hydrochloride

The data stored in your pharmacy IT systems is an important and valuable source of information that, used properly, can assist you in growing your pharmacy business. In this article, John Donnelly outlines an exciting new initiative being introduced for Irish Pharmacies, which will allow participating pharmacies, for the first time, to see trends or changes in product mix and transaction values across the sector and within their own businesses and make informed commercial decisions accordingly.

Turning on your data to maximise your business potential

BUSINESS

L-R: Carlos Mocho, Associação Nacional das Farmácias (ANF); Michael Austin MPSI, Hunters Pharmacy, Windy Arbour, Dundrum, Dublin; John Donnelly, HMR, and Peter Veale MPSI, Veale’s Pharmacy, Cavan at the IPU National Pharmacy Conference.

13IPUREVIEW JUNE 2014

The IPU is constantly looking for new ways to help you develop and strengthen

your business. At this year’s IPU National Pharmacy Conference, we announced details of a state-of-the-art business intelligence service about to be introduced, which will empower you to make great business decisions based on great knowledge.

To date, pharmacies have been excluded from the pharmacy market data stream, which almost all other stakeholders have access to. This situation is no longer sustainable in an age where information and data is required to perform with optimum effectiveness.

Therefore, the IPU has sourced a solution for you, which provides a unique opportunity for those involved in the pharmacy sector to take control of their own data, which, heretofore, has been traded for the financial benefit of others.

In 2009, Associação Nacional das Farmácias (ANF), the representative body for Portuguese pharmacists, realised that they too were being kept in the dark with regard to retail pharmacy data and they formed a company called HMR (Health Market Research) to collect data from their own members. This data is completely anonymised and aggregated so that no individual pharmacy can be identified. So successful was the initiative in Portugal that ANF has recently commenced offering the same service to pharmacies in Spain.

The IPU has taken a considered approach and has embarked on forming a joint company with the ANF called Health Market Research Ireland (HMR Ireland). This newly formed company will leverage the capabilities and technical experience of HMR Portugal, which has already made them the Number 1 provider of pharmacy-related sales data in that jurisdiction. The business intelligence service, which will be delivered by HMR Ireland, will allow participating IPU members to have a forensic view of their business.

Clear reports provided by HMR Ireland will let you see exactly how your pharmacy business is performing. For example, you will see:

n How your business is performing versus historical periods.

n How your business is performing versus your local area and nationally.

n Highlighted business areas where you can improve to meet local and national trends.

n Highlighted business areas where you excel compared to the market.

n Your business, your local area and Ireland broken into categories, brands and products.

n Who the top manufacturers are.

n What the best-selling generic brands and products are.

n What products do not sell and are soaking up your cash flow.

With this typical information you will be able to benchmark your pharmacy’s performance against the local and national pharmacy market and, in turn, make practical, stress-free decisions, which will positively impact on your profitability.

The aggregated data is also hugely important in assisting the IPU to lobby even more effectively on your behalf. As mentioned by Minister Alex White at the recent IPU National Pharmacy Conference, his door is always open, but he also added an important caveat. He wants the IPU to come to the table with facts and figures if they are to negotiate sustainable and viable healthcare services and structures which can be channelled through retail pharmacy in Ireland. Collecting anonymised data from pharmacies will enable the IPU to make representations on your behalf based on real-time up-to-date information and not on the out-of-date drip-fed information currently provided by the reimbursement authorities.

The ANF’s information about their pharmacy sector is recognised as being of higher quality and greater relevance than other data available to the Health Ministry in Portugal. This only emphasises how hugely important it is for all IPU members to support and participate in this new, exciting venture.

This information will be working as hard for you outside your business as it will be within your business.

The IPU, through HMR Ireland, will use its discretion as to who will have access or visibility to the data which is collected. It is the intention that as well as providing members with vital reports that will benefit your business and using the data to lobby on your behalf, HMR Ireland will sell the anonymised and aggregated data to the manufacturing companies as this product will add more value to the manufacturers’ business than the market options currently available. The revenue received for this data will be ploughed back into improved and additional services for IPU members, as the sole focus of the IPU is to protect, promote and strengthen the profession.

For the past number of decades, the data relating to orders placed with your wholesalers and other suppliers has been captured by other agencies and commercialised for their benefit. This information originated from you, yet you had no benefits whatsoever accruing from it. Far from being their customer, you were effectively their product. Now, with the assistance of HMR Ireland, this critical data will not only be back in your hands, it will be working for you!

Next stepsIn the coming weeks, IPU members will be invited to attend our HMR Ireland roadshows, which will be held nationwide. The roadshows are intended to demonstrate the easy use and flexibility of reports and systems which will be available to you. We will be looking for the full support of members to sign up to and back this project, as HMR Ireland has been established with the sole purpose of serving you.

With your support, it is the intention of the IPU and HMR Ireland to deliver unprecedented levels of information and business intelligence to retail pharmacy. Our aim is to continually assist you in running your pharmacy and support you in delivering excellent patient and customer care through innovation and insight.

PROFILE

John DonnellyJohn Donnelly is no stranger to retail pharmacy; in fact, he spent the first year of his life living over his father’s shop, Sean Donnelly’s Chemist, which was originally located at Harmonstown in Dublin and later moved to Portmarnock.

Taking the commercial route, John has seen virtually all sides of the pharmaceutical market, having started his career in Allphar and Allied Pharmaceutical Distributors (APD), now known as Uniphar, before moving to Pfizer Consumer Healthcare in 1999 where he held the position of Sales Director until 2007.

John is also no stranger to the IPU, having developed and presented the recent IPU ‘Strategies for Growth’ business seminars. In these seminars, John drew on his expert knowledge of the pharmacy and FMCG markets to demonstrate to pharmacists how to maximise market data to benchmark their businesses, make informed decisions and, most importantly, improve cash flow. John has not only contributed retail pharmacy articles in the IPU Review but is also considered as one of the top pharmacy retail experts in the UK and regularly contributes articles to the Northern Ireland Healthcare Review, as well as the English, Scottish and Welsh Pharmacy Review magazines. In addition, John has presented as expert retail speaker at both the Scottish and Welsh Pharmacy conferences.

Why not LinkIn with John today.


Please contact your local Bayer Representative for further information

Unique MUPS® technology nowavailable OTC as Losec® Control

Losec Control 20 mg gastro-resistant tablets (omeprazole).For full details please refer to full SmPC. Presentation: Gastro-resistant tablet containing 20mg omeprazole magnesium. Indication: For the treatment of reflux symptoms (e.g. heartburn, acid regurgitation) in adults. Dosage and Administration: Recommended dose is 20 mg once daily for 14 days. It might be necessary to take the tablets for 2-3 consecutive days to achieve improvement of symptoms. The majority of patients achieve complete relief of heartburn within 7 days. Recommend to take in the morning, preferably on an empty stomach, swallowed whole with half a glass of water. Tablets must not be chewed or crushed. Renal impairment: No dose adjustment is necessary in patients with impaired renal function. Hepatic impairment: Patients with impaired hepatic function should be advised by a doctor before taking Losec Contol. Contraindications: Hypersensitivity to omeprazole, substituted benzimidazoles or to any of the excipients; must not be used concomitantly with nelfinavir. Warnings and Precautions: Patients should not take omeprazole as a preventive medication. In the presence of any alarm symptom (e.g. significant unintentional weight loss, recurrent vomiting, dysphagia, haematemesis or melena) and when gastric ulcer is suspected or present, malignancy should be excluded, as treatment may alleviate symptoms and delay diagnosis. Losec Control contains sucrose. Treatment with proton pump inhibitors may lead to slightly increased risk of gastrointestinal infections such as Salmonella and Campylobacter. Patients with long-term recurrent symptoms of indigestion or heartburn should see their doctor at regular intervals. Patients should be instructed to consult a doctor if: they have had previous gastric ulcer or gastrointestinal surgery, they are on continuous symptomatic treatment of indigestion or heartburn for 4 or more weeks, they have jaundice or severe liver disease, they are aged over 55 years with new or recently changed symptoms. Interactions with other medicinal products: Must not be used concomitantly with nelfinavir. Not recommended: Co-administration of atazanavir

with proton pump inhibitors, if combination of atazanavir with a proton pump inhibitor is unavoidable close monitoring is recommended in combination with an increase in the dose of atazanavir to 400 mg with 100 mg of ritonavir; omeprazole 20 mg should not be exceeded. Concomitant use of omeprazole with clopidogrel, posaconazol, erlotinib, ketoconazole and itraconazole should be avoided. Use with caution: Patients treated concomitantly with active substances metabolised also by CYP2C19 (e.g. R-warfarin and other vitamin K antagonists, cliostazol, diazepam and phenytoin), with CYP2C19 and/or CYP3A4 inhibitors such as clarithromycin and voriconazole or with inducers of CYP2C19 and/or CYP3A4 (e.g. rifampicin, St. John’s wort). Concomitant treatment with Digoxin, particularly when given at high doses to elderly patients, or concomitant administration of omeprazole with saquinavir/ritonavir, tacrolimus and methotrexate. Undesirable effects: Common: abdominal pain, constipation, diarrhea, flatulence, nausea/vomiting, headache. Uncommon: dizziness, paraesthesia, somnolence, insomnia, vertigo, increased liver enzymes, dermatitis, pruritus, rash, urticaria, malaise, peripheral oedema. Rare: leukopenia, thrombocytopenia, hypersensitivity reactions (e.g. fever, angioedema, anaphylactic reaction/shock), hyponatraemia, agitation, confusion, depression, taste disturbance, blurred vision, bronchospasm, dry mouth, stomatitis, gastrointestinal Candidiasis, microscopic colitis, hepatitis with or without jaundice, alopecia, photosensitivity, arthralgia, myalgia, interstitial nephritis, increased sweating. Very rare: agranulcytosis, pancytopenia, hypomagnesaemia, aggression, hallucinations, hepatic failure, encephalopathy in patients with pre-existing liver disease, erythema multiforme, Stevens-Johnson Syndrome, toxic epidermal necrolysis (TEN), muscular weakness, gynaecomastia. Marketing Authorisation Holder: Bayer Limited, The Atrium, Blackthorn Road, Dublin 18, Ireland. MA numbers: PA1410/66/1. Further information available from: Bayer Ltd., The Atrium, Blackthorn Road, Dublin 18. Tel: 01 2999313. Date of Preparation: 03.14.

L.IE.CC.04.2014.0251

75105343 Losec_IPU Review_297x210mm.indd 1 23/04/2014 14:04

Actavis launch the ‘Accumulator’ – the partnership that adds up

BUSINESS

On Thursday 1 May, Actavis launched the ‘Accumulator’, a new purchasing model for

pharmacists in Ireland. The ‘Accumulator’ is an innovative pricing scheme, which will change the way Irish pharmacists purchase generic medicines. The simple pack replacement scheme will make it transparent, easy and profitable to purchase generics through full line wholesalers.

Ahead of developing the new purchasing model, Actavis polled over 100 pharmacists to ask what they wanted from a purchasing scheme. Irish pharmacists were clear in their responses, which included: transparent purchasing, consistent supply, the best value, and greater control over their purchases and profits.

It is with these qualities in mind that Actavis has created the ‘Accumulator’. It will be the first ever purchasing model to offer pharmacists transparency, consistency and value across the full product portfolio. Among the benefits, the pricing structure will offer: the best deal in the market on generics, simple prices, full portfolio inclusion and rewards for valued partners.

Launching the ‘Accumulator’ purchasing model at The Convention Centre in Spencer Dock, Tony Hynds, Managing Director of Actavis Ireland,

said “I’m delighted to launch this scheme for independent Irish pharmacy groups. At Actavis Ireland, our goal is to become the champion of first class generics. As a result, we’ve created a package which we believe offers Irish pharmacists the best value, choice and delivery for generics. The ‘Accumulator’ is an innovative proposition, which demonstrates our commitment to offering consistent value and quality to our partners.”

Keith Hynes, Commercial Director of Actavis Ireland, spoke about what the new pricing structure offers their partners “Our customers are at the centre of what we do. Our customers have stressed the need for transparency of pricing, consistency of supply and value across our large portfolio. While pharmacy is facing a huge challenge in margin reduction, the ‘Accumulator’ offers everything our customers have asked for. Our customers are in a unique position within the industry with a scheme which puts them in the driving seat. We’re proud to launch the ‘Accumulator’, which delivers a unique purchasing model within the Irish generics market.”

For further information on the purchasing scheme contact your Actavis Key Account Executive or visit www.actavis.ie.

Pictured from top (L-R): Barry Doyle, Actavis; Damian Flanagan, Uniphar and Damien McCormack at the launch of the Accumulator; Tony Hynds, Managing Director, Actavis Ireland and Jim Curran, Director of Communications & Strategy, IPU; Harry Crosbie, Guest Speaker at the Accumulator launch speaks about embracing change.

Actavis launch an innovative purchasing model for Irish pharmacists.


Tailored to You

Take Control with ActavisSimplifying your business and maximising profitability is fundamental to Pharmacy growth. That is why, at Actavis, we have launched a new innovative purchasing model for customers called the ‘Accumulator’.

The ‘Accumulator’ is a simple pack replacement scheme offering transparency and consistency together with excellent customer service.

The ‘Accumulator’ puts you in the driving seat, offering the best margins and excellent value across our portfolio which will allow you to develop your business with confidence.

THE ACTAVIS ‘ACCUMULATOR’ GIVES YOU MORE:

Transparency – of Pricing, Margins and Invoicing.

Consistency – of Supply, Purchasing and Customer Service.

Value – across Generics, OTC and Branded Medicine.

Control – over your Purchasing, your Profits and your Business.

Actavis and You – The partnership that adds up.

Contact us at 021 461 9040 or on www.actavis.ie to see how the ‘Accumulator’ can be put to work for you.

Date of Preparation: April 2014. NA-019-01.

Supporting Pharmacists Supporting Patients

Top-class speakers, from near and afar, delivered 13 educational sessions at the

Conference. Educational sessions kicked off on Friday afternoon with Enteral Tube Feeding. Attendees heard

from a range of speakers over the weekend, including Dermot Twomey, a community pharmacist in Cork, who has stepped into the future of pharmacy practice by delivering a warfarin clinic in his Cloyne Pharmacy. Attendees also heard from

international business experts Dave Shanahan and Dennis Reid, who gave tips and advice on adapting your business to compete in the future and customer service. The annual public opinion research carried out on behalf of the IPU was delivered

by Behaviour & Attitudes, which showed that 71% of respondents are “strongly in favour” of pharmacists being able to provide services to improve patient adherence to medicines.

UK Pharmacist Andrew Evans discussed new

The fourth annual IPU National Pharmacy Conference took place on 9-11 May in the Slieve Russell Hotel, Ballyconnell, Co Cavan. 170 pharmacists attended over the weekend to expand their continuing education, network and have their voice count at the IPU’s AGM. In this article, Aoibheann Ní Shúilleabháin, Marketing & Events Executive, gives an overview of the weekend’s events.

CONFERENCE 2014 Aoibheann Ní Shúilleabháin. Marketing & Events Executive

18 IPUREVIEW JUNE 2014

developments in veterinary medicines in Ireland during his session, which worked as a guide to selling veterinary medicines in a Community Pharmacy. The Resilience & Stress Management session gave practical tips to attendees on how to manage their workload and therefore get the best out of business.

Clinical issues covered also included the Management of Ankylosing Spondylitis, Epilepsy, Understanding Alcohol Misuse, Schizophrenia, Common Dermatology Conditions and Stoma. Some of these topics will be covered in this and next month’s IPU Review as part of the CPD series.

A certificate of attendance has been issued to all attendees for their CPD portfolios.

Exhibition HallThe Exhibition Hall was even bigger and better this year, with a number of new companies exhibiting over the weekend. Pharmacists had plenty of opportunities to build on relationships through networking with representatives from the pharmaceutical and pharmacy business industry. 33 companies were in attendance to showcase their products and services, with a number of companies running special offers at their stands.

There was a great atmosphere throughout the Exhibition Hall as pharmacists met with representatives from leading suppliers to community pharmacy over coffee and cocktails. See photos from the Exhibition Hall on pages 54 to 57.

“ Community pharmacists who are literally at the frontline of primary care are, and will be, instrumental in actively promoting health initiatives and in keeping people healthy.”

Alex White, TD, Minister of State for Primary Care

Opening Address by Minister Alex WhiteMinister of State for Primary Care, Alex White TD, addressed attendees at the Conference on Saturday morning. He began by acknowledging and paying tribute to the dedication, professionalism and commitment of community pharmacists. He highlighted the hugely important role that community pharmacists have and their critical role in improving health and wellbeing and treating patients in the communities. He welcomed engagement with IPU in implementation of Government policy, particularly the Healthy Ireland strategy.

“Pharmacists have an important role – a critical role – in the reform agenda. Community pharmacists who are literally at the frontline of primary care are, and will be, instrumental in actively promoting health initiatives and in keeping people healthy,” he said.

“Improvements in Primary Care in Ireland rely on the evolving nature of the community pharmacy and the continued development of evidence-based best practice and quality patient care. Minister Reilly and I are very supportive of a further expansion of the role

of community pharmacy, in particular into areas such as chronic disease management and health screening.”

The Minister also highlighted the importance of pharmacists’ continuing education, which will allow for the expansion of the role of pharmacists to deliver new services.

He discussed the introduction of Reference Pricing and the importance of ensuring the prices set do not affect the continuance of supply of medicines to patients. He expressed his gratitude of the implementation of the new system and the contribution pharmacists have made, which has been well noted by the Minister and the Government.

The Minister stressed that there are challenging times ahead, especially when implementing the reform programme. However, it will bring about real change, which will benefit every citizen.

“As health professionals with a pivotal role in the delivery of a modern, high-quality, patient-centred primary care services, I look forward to your continued support and cooperation as we progress along this continued reform journey,” he concluded.

IPU President Rory O’Donnell responded saying the last few years have been very difficult. “Pharmacists have been attempting to keep the ship afloat during extremely difficult times. Constant cuts to pharmacy incomes have ensured that

Minister of State for Primary Care, Alex White TD,

Rory O’Donnell


we are attempting to do much more for much less, and at the same time to care for our patients, protect our profession, protect our businesses and indeed to protect our jobs.”

Rory described the impact of the most recent FEMPI cuts and the introduction of Reference Pricing to pharmacists’ incomes. Pharmacists have contributed well over €600m in savings to the State, both directly and indirectly, since 2009.

“The reality, Minister, is we have done more than our bit and we have no more to give. It is time for the FEMPI Act to be repealed, or at the very least, set aside.

“Community pharmacists should be enabled to play an even stronger role than we are allowed to at present, at the heart of more integrated community-based, out of hospital services, that support better outcomes for patients, provide more personalised care, deliver an excellent patient experience, optimise the use of medicines and secure the most efficient use of our healthcare resources.”

Rory highlighted the services that pharmacists could provide, such as chronic disease management and MURs, and reported on the services provided by pharmacists in other countries and the positive outcomes from the expanded role of pharmacists.

“The theme of the Conference, Supporting Pharmacists Supporting Patients, encapsulates what this weekend is all about and what we as a profession are all about.”

Panel discussionThe Panel Discussion was a lively debate with some exciting comments, including announcements on reduced PSI fees and medicines being switched from POM to pharmacy only. Sean O’Rourke, chair of the Panel Discussion, opened the event and welcomed everyone and introduced the members of the Panel.

Mr O’Rourke commenced the discussion by asking IPU President Rory O’Donnell how he would assess the progress made in terms of the expansion of the role of pharmacists. Rory replied that, “when we see the progress that has been made in other countries, it’s very embarrassing how slow progress has been in Ireland despite our very best efforts.” He highlighted that the IPU constantly hears from policy makers that the expansion of the role of pharmacists is a good idea, but nothing has been done. While the expansion in terms of EHC and the Vaccination Service is a welcome movement, there is so much more that can be done, as is the case in other jurisdictions.

Dr Cate Hartigan, Head of Health Promotion and Improvement, Health & Wellbeing Division, Health Service Directorate, joined the discussion saying that it was a no brainer, with the footfall that community pharmacies have, to deliver an extended role. She pointed out though, that things can take their time in the public sector to reach an agreement from key stakeholders or legislative.

Consumer journalist Conor Pope also gave his opinion on the topic: “I thought it was interesting that Minister White said that pharmacists’ role was critical and identified four areas that pharmacists had made a major impact”, those being advice on healthy eating, smoking cessation, EHC and advice on taking medication. “I think that if that is the best that the Government can say that they have done to improve the role that pharmacists play in the wellbeing of our citizens, it’s shameful. A whole lot more needs to be done.”

A discussion then followed on availability of medicines from pharmacy only, rather than prescription only medicines (POM), which prompted IMB Chief Executive Pat O’Mahony to announce: “The IMB is now embarking on a proactive approach to the switching of medicines from POM to pharmacy only.” Mr O’Mahony said that they are working on a list of 20 medicines that could be switched, but that there would be an announcement in June regarding 12 medicines.

Rory O’Donnell replied that he hoped the IMB list of medicines will be rolled out as quickly as the reference pricing lists.

Questions were then opened up to the floor, where first up was Dermot Twomey, who had also presented at the Conference on the Friday night. Dermot highlighted the benefits, both for patients and the State, in the services that pharmacies can provide.

Dr Cate Hartigan Pat O’Mahony, IMB


He informed the Panel of his Anticoagulation Clinic that has been in his pharmacy for the last four years, where audits have shown that the service standards are superior to that provided in local hospitals and that the pharmacy is more cost-effective at providing the service than the State.

Other issues raised included a query regarding courier services by pharmacies. Marita Kinsella, Registrar of the PSI, said that the pharmacist is responsible for when the medicines leave the pharmacy until it reaches the patient. Guidance will be issued by the PSI on how to manage delivery services shortly.

Another question for Ms Kinsella involved the issue of inspections in pharmacies. Pharmacists had been receiving notifications of inspections, but this practice had stopped recently. Ms Kinsella said that a pilot ran for a few months, which gave pharmacists 24 hours’ notice, but was not in place now. She said that the PSI Council is conducting a strategic review of Inspection Policy and a new

model will be in place in 2015. She also announced that PSI fees will be reducing by 5%.

There was a lot of discussion on the price of medicines in comparison to other countries. Members highlighted that there has been a reduction in price of medicines and asked that Conor Pope acknowledges this. Mr Pope made his usual comments regarding the difference between the price of medicines in the Republic of Ireland and Northern Ireland. However, Siobhán McNulty, who has a pharmacy in Northern Ireland (and is also a member of the IPU), spoke up to dispel the myth that pharmacies in Northern Ireland are still profitable despite the cheaper medicines. Ms McNulty highlighted that the lower prices are great for patients but not for pharmacies. The crucial

difference between the two markets is that pharmacies in Northern Ireland don’t make anything on private patients but receive additional funds from Government, such as professional fees, fees for services and rural pharmacy fees.

Ms McNulty highlighted that, in Northern Ireland, the minimum wage is lower, as are Society fees. Pharmacies will go to the wall if Government keeps reducing the price of medicines and not paying professional fees to pharmacists, she concluded.

Sean O’Rourke invited the Minister to address attendees again in relation to some of the issues raised during the discussion. The Minister stated that Government doesn’t intend to cut further professional fees paid to people providing services to

“ When we see the progress that has been made in other countries, it’s very embarrassing how slow progress has been in Ireland despite our very best efforts.”

Rory O’Donnell

the public. “Our principal objectives as policy makers are in the interest of patients,” he said.

The Minister went on to say that there is a great deal happening in healthcare but things have to move forward in a gradual way. He stressed that two or three initiatives need to be identified to start working on over a few months, which can be taken from the submission that the IPU made a number of months ago.

Launch of hmRFollowing the Panel Discussion, John Donnelly addressed attendees about the introduction of Health Market Research Ireland, a company providing a new service for pharmacists, in partnership with the Portuguese National Pharmacy Association (ANF). This state-of-the-art business intelligence service will allow participating members to see trends or changes in product mix as well as transaction values across the sector and within their own businesses. The service will provide participants with access to accurate, up-to-date information, to assist them in running their business more efficiently and in benchmarking performance against the local and national pharmacy market.

Mr Donnelly explained that the data will be completely anonymised and aggregated. Roadshows will be held around the country in the coming weeks/months with further details of this initiative.

Marita Kinsella, PSI Paul G. Ryan


President’s DinnerThe President’s Dinner was held on Saturday night and had guests in attendance from other organisations such as the National Pharmacy Association (UK), Ulster Chemists’ Association, PGEU and many more.

Kathy Maher was MC for the night and welcomed everyone to the dinner. She thanked all the sponsors and exhibitors of the Conference and invited Paul G Ryan, Group Sales and Marketing Director, Uniphar, to give a short speech, as Platinum Sponsors for the fourth year running.

Rory O’Donnell addressed guests and thanked those he had worked closely with over the previous two years during his term as President. He concluded his speech with a short song, showcasing one of

his many talents. A raffle was held for the

Pharmacy Benevolent Fund at the dinner and, thanks to everyone’s generous support, €5,500 was raised. The money raised is vital to continue the good work of the Benevolent Fund and is greatly appreciated by those involved. The raffle was followed by a jazz quartet, bringing the dinner to a close.

New President takes officeThe AGM took part in two sections over the weekend; the reports were held on Friday night and the Motions took place early Sunday afternoon. The incoming President, Vice-President and Honorary Treasurer took up their new positions at the close of the Conference.

Rory O’Donnell presented Kathy Maher with the President’s Chain at the close of the AGM on Sunday afternoon. Kathy was previously Vice-Chair and Honorary Treasurer of the IPU and her term as IPU President will last for two years. Vice-President Daragh Connolly and Honorary Treasurer Bernard Duggan also took up their positions for their two-year terms.

Thank you to everyone who took the time to complete the online survey. The IPU aims to provide the best benefits and services for members, and we hope that those of you who attended felt we did. If not, please tell us. Or, if you did not attend the conference, we would also love to hear why. You can email feedback to [email protected].

Save the date for 2015If you weren’t able to attend this year’s Conference, make sure you save the date for 2015. We are heading to the Kingdom, where the IPU Conference will be held on 24-26 April in the Malton, Killarney. The setting will, of course, be beautiful, but the real beauty is the investment you will make in the success of your business.

Log on to

www.pharmacyconference.ie to see photos from the weekend.

Kathy Maher receives her chain of office from outgoing IPU President, Rory O’Donnell


Comfort

Aptamil Comfort is different to a standard infant formula as it contains key ingredients for the dietary management of colic and constipation1-4

95% of paediatricians reported a positive clinical improvement1

IMPORTANT NOTICE: Aptamil Comfort is a food for special medical purposes. It should only be used under medical supervision, after full consideration of the feeding options available including breastfeeding. Suitable for use as the sole source of nutrition for infants from birth, and as part of a balanced diet from 6-12 months. Not suitable for enteral use.

REFERENCES: 1. Savino F et al., Acta Paediatrica Supp 2003; 441:86-90. 2. Veitl V et al., J Ernahrungsmed 2000; 2:14-20. 3. Savino F et al., Eur Jl Clin Nutr 2006; 60(11):1304-10. 4. Schmelzle H et al., J Pediatr Gastroenterol Nutr 2003; 36:343-51.

For healthcare professional use only

Partially Hydrolysed Protein (100% whey) Reduced Lactose Thickened Formula Betapol fat blend

Aptamil_Comfort_Ad_03.indd 1 05/12/2013 10:18

The idea to set up the Cloyne Pharmacy Anticoagulant Clinic was born out of my discovery that a particular patient was frustrated in having to get his International Normalised Ratio (INR) measured at a hospital in Cork City. This required an early morning start, cost of fuel and cost of parking as well as time spent in traffic; all of which is very stressful for the many elderly patients who suffer from Atrial Fibrillation. Indeed, many of our patients needed a carer to help them make this journey which resulted in the carer having to take time off work as well.

In 2009, I completed a patient survey of all patients taking warfarin and asked if they would like to have their INR measured closer to home in Cloyne Pharmacy and if they would pay for the service. Approximately 65% of those surveyed indicated that they would be happy to do so.

We now had an interested patient cohort and I completed training at the Xcellerate Skillnet Anticoagulation Management course in April 2009 at UCC under Prof. Stephen Byrne and subsequently met with Consultant Haematologist Dr Susan O Shea who encouraged me to develop my idea to set up a pharmacy-based anticoagulant clinic at Cloyne Pharmacy. I subsequently

spent time at Cork University Hospital (CUH) observing dosing techniques for patients on warfarin and, together with Dr O Shea, developed the operation protocols for Cloyne Pharmacy Anticoagulant Clinic.

Cloyne Pharmacy Anti-coagulant Clinic started in February 2010 as a ‘satellite’ clinic of CUH, using the same protocols as the CUH warfarin clinic team. We measured INRs using a point of care meter, Coaguchek XS Plus and adjusted the warfarin dose if the patients INR was outside their agreed therapeutic range. Initially, we were in frequent contact with the hospital team as we needed support and guidance in such situations. All our results were faxed to the Consultant Haematologists

who would review dose adjustments, sign off on it and reply, by fax, to us.

After the first year under this system, an informal external assessment of my knowledge and protocols was carried out by a different Consultant Haematologist. At this stage, I was declared competent and thus able to work under less direct supervision from CUH. However, we continue to operate a protocol where if an INR result is <1.5 or > 5.0, the Consultant Haematologist or Registrar is contacted.

At the same time, Cloyne Pharmacy Anticoagulant Clinic moved from the paper-based system, to a computer-based programme, Raid Express.

Key informationWhen accepting a new patient to Cloyne Pharmacy Anticoagulant Clinic, the following key information is required:

n Patient Name and Address;

n Hospital Medical Record Number;

n Date of Birth;

n Indication for Warfarin use;

n INR Range;

n Therapy Duration;

n Initial and recent Warfarin doses;

n Initial and recent INR results.

CPD Dermot Twomey, MPSI

RECORD(e.g. portfolio)

Learning planEvaluation

Reflection and self-assessment

Action (e.g. CE)

CPD: A community pharmacy anticoagulant clinic – how it exceeds best practice for patient care


Warfarin indication and dose The dose of Warfarin is dependent on both indication and required INR.

Reflect and Self-Assessmento Is there a need in my locality for this service?

o Have I enough pharmacist cover to start providing this service?

o What level of training do I need?

o Do I routinely counsel patients and their carers effectively on the use of warfarin?

Learning PlanIncluding a list of desired learning outcomes in a personal learning plan is a helpful self-analytical tool.

o Create a list of desired learning outcomes.

o Review professional resource materials available in the pharmacy and source additional material if necessary.

o Review patient support material and source additional material if necessary.

ActionActivities chosen should be outcomes based to meet learning objectives.

o Review with patients their INR measurements.

o If interested in learning more and considering setting up a clinic in your pharmacy, contact Prof Stephen Byrne at UCC ([email protected])

o Evaluate professional resource materials available in the pharmacy and source additional material if necessary.

o Evaluate patient support material and source additional material if necessary.

EvaluateConsider outcomes of learning and impact of learning.

o Have I changed my management of patients taking warfarin?

o Am I now confident to engage with patients taking warfarin?

o Will I explore setting up a similar service in my pharmacy?

o Have I met my desired learning outcomes?

o Have further learning needs been identified?

Recordo Create a record in my CPD portfolio.

o As part of this record, complete an evaluation, noting whether learning outcomes were achieved and identifying any future learning needs.

CPD overviewIndication INR Range Duration of Therapy

Atrial Fibrillation (AF) 2 - 3 Normally lifelong

Deep Vein Thrombosis (DVT) 2 - 3 Three months

Pulmonary Embolism (PE) 2 - 3 Six to 12 months

Valve Replacement (high risk mechanical)

3 - 4 Lifelong

Valve Replacement (bio-prosthetic)

2 - 3 Six months (if no other risk factor,

i.e. AF or PE)

The other factor to take into consideration is the frequency of INR measurement.

Initially, INR is measured every 2-3 days and once a consecutive number of measurements within the agreed range are recorded, a schedule of weekly measurements can be introduced.

Rule of thumb – when INR is in range, the interval can be extended by one week, up to a maximum of 4-5 weeks. If INR is out of range, then it’s back to weekly checks again.

Factors that affect the warfarin dose are genetics, age, race, body surface area, concurrent medication and co-morbidity.

In Cloyne Pharmacy, I have developed an Acronym WARfarin UPFRONT TM, which combines the best use of patient factors known to the pharmacist with computer dose software (CDSS) to help with warfarin dose adjustment.


The graph below shows the TTR calculated by the researcher, Olivia Lyons, (72.16%) and that calculated using Raid Express software-system (76.81%) using different methods of calculation. The corresponding TTR for CUH was 59%.

Advantages of a community pharmacy anticoagulation clinicn Patients prefer point of

care to venepuncture as it is less painful in terms of obtaining a blood sample; indeed some GPs refer patients to us for this reason.

n There is potential to improve compliance with face-to-face dose adjustment rather than remote dose adjustment over the phone; certainly the pharmacist / patient relationship is much enhanced.

n Warfarin dose adjustment and INR measurement is being performed at the lowest level of complexity which frees up secondary care for more complicated cases.

n A single healthcare practitioner is involved in the consultation, education and agreement of treatment plan.

n The INR result and dose adjustment (if required) at the same sitting – no delay in waiting for INR results to return from the hospital.

n More likely to be able to spot an interacting medicine in the pharmacy setting and then reschedule an appointment to mitigate its impact. Often, it is left up to the patient to make a follow up INR appointment if there is a drug interaction.

n The machine is portable and we have made home visits on occasion.

n Community Pharmacy is very accessible (in terms of location and availability) and while we generally schedule appointments, we can in an emergency, measure an INR on the spot if necessary.

n We have had 100% satisfaction in a recent patient survey.

Key pharmacist advice points for patients taking warfarin:n Tailor the explanation to

the individual patient as to why they are now taking warfarin. Counselling patients about their treatment has been shown in many studies to lead to improved patient knowledge and quality of anticoagulation. It can often take 3-4 weeks until a new patient’s INR is stable, reassure the patient that this is normal.

n Record on the PMR the indication for warfarin treatment, and when/if they are due to finish treatment; to ensure appropriate duration of treatment. This is particularly important for patients on warfarin for a finite duration, i.e. PE or DVT.

n Repeat prescriptions should not be issued unless the patient is regularly attending clinic, INR is within safe limits and the patient understands correct dose to take.

n People on holidays from abroad; find out where they can get their INR checked locally.

n When is the correct time to take warfarin – once a day at any time; however, if they are getting an INR measurement in the morning, they should not take warfarin prior to the test.

n If you forget a dose – take as soon as remember if before midnight, otherwise omit the dose and continue as before – inform warfarin clinic at next test.

n Pharmacists should have sight of a patient’s INR book so that they can view INR measurements and attendance at clinic is okay.

n DNAs (non-attenders at warfarin clinics) – must be followed up as their risk of a clot or bleed is increased when not being regularly monitored.

WARfarin UPFRONTTM

W stands for weekly – key is that warfarin dose is calculated on a weekly basis and any adjustments in dose take this into account. Daily dose adjustment doesn’t work for warfarin. We look at both the current INR and retrospective dosing and review the effect it had and try to guestimate the prospective dose.

Availability – Cloyne Pharmacy Anticoagulant Clinic operates generally 1-2 days per week; however, we are available six days per week, if necessary, to measure an emergency INR.

Ready to help with other healthcare issues as they pop up, i.e. inhaler technique monitoring, MUR etc.

Upward/Downward trend – using the CDSS we plot graphs of INR measurements and use trending to see if dose adjustment is required – even if the INR is within range.

Past history is often a predictor of future trends, e.g. if a patient starts an antibiotic, review to see what, if any, effect it had on INR previously.

Frontload changes to get the desired effect; i.e. if INR is high we will omit a dose; if it is low we will boost a dose.

Relevant communication with other healthcare professionals – key, especially if INR is outside desired range.

Other factors may affect INR – watch for alcohol intake, change in medicines and diet.

Need to record reasons for dose adjustments on CDSS – as a memory aid – why change was made and also for another pharmacist to understand the dose adjustment.

Time in therapeutic range – must audit individuals and the practice to see how it is performing.

Test frequency – if unsure regarding a complicated patient’s INR, then test often until stable.

In a recent two-year retrospective study of the Cloyne Pharmacy Anticoagulant Clinic versus CUH, the Cloyne Pharmacy Anticoagulant Clinic met international standards by exceeding Standard 1 of the British Committee for Standards in Haematology

(BCSH) guidelines for anticoagulation control of >60% time in therapeutic range (TTR) as calculated using the Rosendaal method. This looks at the amount of time between visits to determine how long the patient might have been within their therapeutic range.

Black arrow represents standard 1 set by the British Committee for Standards in Haematology Guidelines 2005-ie. 60% of INR results must be within 0.5 INR units of target range.


Your 5-minute assessment

Answer the following questions:

1. A patient comes home from a night out at the Theatre at 12.30am and has forgotten to take their warfarin dose earlier – should they take it now or not?

2. If an Atrial Fibrillation patient had the following INRs: 1.2, 1.3, 1.1 over the past two months, what is the likely reason?

3. What is the duration of therapy for a Pulmonary Embolism?

4. The BCSH guidelines for anticoagulation recommend a time in therapeutic range for warfarin of what %?

Answers:1. If forget a dose – take as soon as remember if before midnight, otherwise omit the dose and continue as before – inform warfarin clinic at next test. 2. Poor compliance is the most likely reason for such low INRs. 3. 6-12 months. 4. 60%.

n Give appropriate advice to the patient when to get next test done if an interacting medicine is prescribed.

n Ensure appropriate dispensing of the same brand of warfarin. Be aware of the variation in INR results from using different brands.

n Reaffirm messages re moderation of lifestyle, alcohol, OTC and herbal

medicines. This information is often lost in a haze when a patient is discharged from hospital. Patients are often worried so will need reassurance. Often patients feel that they have to avoid all green leafy vegetables but this is not the case.

n Ideally, patients should get written and verbal information regarding their dose and any dose adjustments.

n Avoid including warfarin in monitored dose systems as dose often varies.

ConclusionsCloyne Pharmacy Anticoagulant Clinic is meeting anticoagulation international standards. This has led to increased patient safety with the provision of a local and accessible service. Both clinic and patient costs in the

primary care setting are cost effective. This service has led to reduced costs in the secondary care setting. Results from the recent two-year retrospective study would support anticoagulation management work from other community pharmacies in Ireland.

34, Vevay Road, Bray, Co Wicklow. Tel. 01 524 2248 [email protected] www.dressings-direct.com

You DISPENSE generic MEDICINES,so why not

generic WOUND DRESSINGS?Our dressings are30-45% better valuethan equivalent branded dressings.

They come in easily identifyableand attractive retail packs consisting of only two dressings so you don't make a loss on larger packs thatyou can't sell!

Teleorder from United Drug as : Foam Dressing (PU) 10x10cm Adh Border Orange BNF Section A5.2.5 Page 1043Foam Dressing Silicone 10x10cm Adh Border Brown BNF Section A5.2.3 Page 1040Hydrocolloid Dressing 10x10cm Adh Border Green BNF Section A5.2.4 Page 1043

Dressings-Direct.com

Teleorder from United Drug as :

Handy Retail Packs of 2 dressings.Avoid making a loss on larger pack sizes you can’t sell.

RBMedicalPartnership.comwww.rbmedicalpartnership.com

*DDC IPU Half-Page Amend v1.indd 1 26/05/2014 21:19IPUREVIEW JUNE 2014 27

Uniphar Pet Health - looking after your pet in summer

ADVERTORIAL

Decreased consumer spending power is the principal contributor to the fall in non-dispensing sales. Over the last two years, front of shop turnover has decreased by 38.54% (Retail Pharmacy Benchmarking Study 2012 – Touchstore).

With six out of 10 customers owning a dog and almost as many owning a cat many pharmacies are now pursuing this opportunity.

Uniphar have tailored their companion animal offering to help pharmacies without experience to capitalise on this opportunity.

Uniphar’s new ParexTM Spot-on Flea (non-prescription) treatment is now completing the Companion Animal Starter Pack to provide a comprehensive product offering.

ParexTM is a Spot-on Flea treatment – is a topical “spot on” application for the prevention of � ea infestation and biting lice on cats and kittens and biting lice (Trichodectes canis) in dogs. ParexTM has a rapid onset of action and kills re-infestations with newly acquired adult � eas.

It can be used on kittens from eight weeks of age and weighing at least 1kg and is safe to use on breeding, pregnant or lactating animals.

The arrival of a spot-on treatment for � eas and ticks will complete the pet offering from pharmacies and Uniphar is committing huge support to driving sales into pharmacies.

The fact that ParexTM is off prescription allows it to be advertised and there is scope to double sales in the market. The promotion of ParexTM is now being promoted on TV 3 with a campaign lasting over several weeks. Pharmacies are advertising in their local papers and with posters in their windows. Facebook is being extensively used to

promote ParexTM. It was promoted at the IPU Conference and the cosmetics show and is now available from pharmacies throughout the country.

For pharmacies looking to increase sales in the front of shop, the Uniphar pet opportunity offers a compelling case, with Point Of Sale, low cost, little shelf space, competitive pricing, and technical support.

Parex™ the non-prescription spot-on fl ea treatment for dogs and cats

C

M

Y

CM

MY

CY

CMY

K

A4 Advert Uniphar April 2014.pdf 1 14/04/2014 16:12

Allphar Pages JUN2014 ART.indd 1 26/05/2014 21:22


C

M

Y

CM

MY

CY

CMY

K

A4 Advert Uniphar April 2014.pdf 1 14/04/2014 16:12

At the recent IPU National Pharmacy Conference, Dr Ceara Belviso spoke on the advances in the management of ankylosing spondylitis. Dr Belviso worked as Consultant Rheumatologist in the Mid-Western Regional Hospital, Limerick, before joining MSD as Associate Director Medical Affairs, where she supports the Biologics Business Unit.

Ankylosing Spondylitis (AS) is a chronic inflammatory disease that preferentially affects the axial structures (spine, sacroiliac joints, anterior chest wall). Peripheral joints are affected in 20-30% of patients and it is also associated with inflammation of the enthesis (where tendon meets periostium and bone). AS is characterised by the formation of new bone (ossification), which follows inflammation and erosive structural damage to the joints. This new bone formation is what leads to the stiffness patients can experience and can cause fusion (ankylosis) of the vertebrae. The first published clinical description of Ankylosing Spondylitis was in 1693 by an Irishman, Bernard Connor (1666-1698), who studied medicine in France.

AS is one of a group of Spondyloarthritides (SpA), which includes AS, Psoriatic arthritis, SpA with

Inflammatory Bowel Disease (IBD) and Reactive arthritis. All these forms of arthritis share common features. There is a genetic component. The gene HLA-B27 is associated with AS but if you have the gene, you will not necessary develop the disease – 90% of AS patients are HLA-B27 positive but less than 5% of HLA-B27 positive subjects will develop AS so it is thought that some environmental factor, like a bacterial infection, may trigger its development.

Up to 1% of the Irish population has AS. It is three times more common in males than females. 80% of patients will get first symptoms before the age of 30. It is not more common in smokers but smokers tend to have a worse outcome. There is often a delay between onset of symptoms and diagnosis. The current average is approximately seven years. As early treatment is associated with better outcomes, it is

important to identify patients with inflammatory rather than mechanical back pain so that they can be referred to a rheumatologist.

Rheumatological manifestations of ASn Inflammatory back pain,

which is characterised by:

– Back pain for more than three months plus at least four of the following:

• Age at onset <40 years.

• Insidious onset.

• Awaking during second half of night because of pain/morning stiffness (with improvement upon getting up).

• Improvement with exercise.

• No improvement with rest.

n Fatigue – a major problem for patients which is very difficult to treat.

n Peripheral Manifestations:

• Enthesitis – ligament and tendon inflammation at point where they attach to bone. Common sites include behind the heel (achilles tendonitis), the heel pad (plantar fasciitis) and the tibial tuberosity.

• Peripheral arthritis – often get large joint involvement, e.g. knee, hip.

• Uveitis – inflammation of the uvea which includes the iris, ciliary body and choroid.

• Dactylitis – entire length of finger/toe swollen (“sausage toes”).

• Inflammatory Bowel Disease – 5-10% of AS patients have IBD. 60% of AS patients have asymptomatic bowel inflammation.

CPD Fearghal O’Nia, MPSI

RECORD(e.g. portfolio)

Learning planEvaluation

Reflection and self-assessment

Action (e.g. CE)

CPD: Advances in the management of Ankylosing Spondylitis


• Cardiovascular and Pulmonary involvement – seen less since the use of newer treatments.

• Osteoporosis – both male and female patients should be monitored.

Socioeconomic impactIt is estimated that the cost to treat AS is between €10,000 – €15,000 per patient, per year. A recent study found that 76.5% of patients who deemed themselves unemployable at baseline deemed themselves employable at week 256 of treatment so, although biologic treatment is expensive, there is real socioeconomic benefit.

TreatmentThe main treatment objectives are to alleviate pain, restore mobility and prevent disability.

Non-pharmacological management This includes muscle strengthening and weight loss and has been shown to be of great benefit. All patients should see a physiotherapist and follow their exercise programme. Patients who do exercise tend to have better outcomes. Patients should also be encouraged to wear good shoes.

Non-Steroidal Anti Inflammatory Drugs (NSAIDs)NSAIDs improve the symptoms of the disease by reducing pain and inflammation. The full anti-inflammatory dose should be taken. NSAIDs are much more effective in AS than in treating mechanical back pain. Continuous treatment with NSAIDs appears to reduce radiographic progression of the disease which is why patients who are prescribed biologic treatment are also left on NSAIDs. These drugs are associated with gastrointestinal, renal and cardiovascular side-effects. If patients with only axial symptoms do not respond to NSAIDs they may be moved straight on to

biologic treatment. If there are peripheral symptoms, sulphasalazine may be tried. Usually, a patient is considered suitable for anti-TNF treatment if they have failed two courses (12 weeks) of full dose NSAIDs.

Disease Modifying Anti Rheumatic Drugs (DMARDs)The DMARD most commonly used in the treatment of peripheral arthritis in AS patients is sulphasalazine. This is only effective for peripheral arthritis. Sulphasalazine may also be useful if there is co-existing IBD. There are conflicting reports regarding the effectiveness of methotrexate and so it is used less in AS patients. The main concern with these drugs is the risk of infection due to the reduction of white blood cells.

CorticosteroidsSteroids are generally not used in the treatment of AS. If they are needed to reduce inflammatory features of the disease, injection into the joint is usually preferred to the oral route. If oral steroids are started, a plan should be in place for when and how they should be stopped to avoid patients being on them long-term.

Biologic DMARDsTumour Necrosis Factor Inhibitors (anti-TNFs) are the only biologic treatments licensed for the treatment of AS. Currently, there are five licensed: Infliximab, Adalimumab, Etanercept, Certolizumab and Golimumab.

These treatments have been shown to improve clinical measurements of disease activity, improve function and improve quality of life. They cannot reverse damage done, so the earlier a patient is started on them the better. If a patient is started on a biologic at the early stage of the disease, it may slow the progression of the disease. If started at a later stage, the inflammatory pathways have already been switched on, so biologics will not slow

Reflect and Self-Assessmento Am I aware of the pathophysiology of Ankylosing Spondylitis

(AS) and the factors that may lead to its development?

o Can I evaluate all recommended pharmacological and non-pharmacological treatment options for AS?

o Can I manage my patients with AS better by integrating my knowledge of the condition and its treatment into my daily practice?

Learning PlanIncluding a list of desired learning outcomes in a personal learning plan is a helpful self-analytical tool.

o Create a list of desired learning outcomes.

o Review professional resource materials available in the pharmacy and source additional material if necessary.

o Review patient support material and source additional material if necessary.

ActionActivities chosen should be outcomes based to meet learning objectives.

o Develop appropriate guidelines to ensure that patients with AS and their carers are offered appropriate advice and counselling.

o Evaluate professional resource materials available in the pharmacy and source additional material if necessary.

o Evaluate patient support material and source additional material if necessary.

EvaluateConsider outcomes of learning and impact of learning.

o Am I now confident to engage with and counsel patients with AS and their carers?

o Have I changed my management of patients with AS?

o Have I met my desired learning outcomes?

o Have further learning needs been identified?

Recordo Create a record in my CPD portfolio.

o As part of this record, complete an evaluation, noting whether learning outcomes were achieved and identifying any future learning needs.

CPD overview


disease progression, which is why NSAIDs are also used in combination with biologics for these patients.

There are case reports that show that treatment with biologics also reduce the occurrence of other symptoms, e.g. uveitis.

If a patient has no response at all after 12 weeks of treatment, this is referred to as a primary non-response. If there is a response at first but then the treatment stops working, it is referred to as a secondary non-response. In both cases, a different anti-TNF will usually be tried.

Considerations before starting biological therapiesn Tuberculosis screening.

n Hepatitis status – biologic treatment may reactivate the virus.

n Malignancy screening – patient should be up-to-date with age appropriate cancer screening.

n Congestive heart failure screening.

n Infection status.

n Up-to-date vaccinations – ok to get inactive vaccines but should not get live vaccine (e.g. yellow fever) while on treatment. Flu and

Pneumococcal vaccination is recommended.

n Pregnancy testing.

n Family history of demyelinating disease.

Side-effects of anti-TNF therapy include infections, injection site reactions, vasculitis and increased risk of melanoma and other skin cancers.

The role of the pharmacistn Facilitate an earlier

diagnosis of AS and therefore improve patient outcomes by identifying patients with features of Inflammatory Back Pain.

n Counselling patients about their medication therapy. Certain biologics have recently given new guidelines for alternative storage, e.g. Humira®: when needed (for example when travelling), a single Humira® pre-filled syringe may be stored at room temperature (up to 25°C) for a maximum period of 14 days – be sure to protect it from light. Once removed from the refrigerator for room temperature storage, the syringe must be used within 14 days or discarded, even if it is returned to the refrigerator.

n Patients collecting prescriptions for uveitis – check if they have any symptoms of inflammatory back pain.

n Encourage patients to follow their exercise programme. Give advice on weight loss.

n Ensure patients on DMARDs and biologics are getting regular blood tests and that they know they should stop, or reduce, their dose in the case of adverse events including infection.

n Each year, offer flu vaccination to all patients on DMARDs and biologics. Also encourage other vaccinations, e.g. pneumococcal every five years, Hepatitis B.

n For patients on biologics, recommend periodic skin analysis because of risk of skin cancers. Advise on use of sunscreen and avoiding the sun – see Irish Cancer Society website, www.cancer.ie, for guidelines.

n Advise patients on biologics to avoid live vaccines, e.g. yellow fever.

n Get the number for the clinical nurse specialist in the rheumatology department of your local hospital. They can be a

very useful contact to have in sorting out issues with High-Tech prescriptions. For private rheumatologists, it may be useful to have the contact details of their secretary.

n Encourage patients to carry their patient alert card with them.

Further information for pharmacists and their AS patients.The Ankylosing Spondylitis Association of Ireland recently produced a booklet, SUAS (Supporting and Understanding Ankylosing Spondylitis). This can be ordered or downloaded from their website, www.ankylosing-spondylitis.ie. They have also produced a SUAS iPhone app and a booklet called Back in Action specifically for healthcare professionals. SUAS booklets can also be ordered from Arthritis Ireland, www.arthritisireland.ie, who also produce a wide range of booklets about arthritis.

Your 5-minute assessment

Answer the following questions:

1. List the criteria for inflammatory back pain?

2. What percentage of patients with AS have peripheral arthritis?

3. List three possible extra-articular manifestations of AS?

4. What treatment option is used for treatment of peripheral arthritis associated with AS?

5. List two diseases that need to be screened for prior to commencement of biological therapy?

Answers:1. Present for >3 months, plus at least four of the following: Onset <40 years of age; Insidious onset; Improves with exercise; No improvement with rest; and/or Night pain which improves on getting up. 2. 20-30%. 3. Any three of the following: Uveitis; Cardiovascular disease; Pulmonary disease; Renal disease; Neurologic disease; Gastrointestinal (GI) disease; and/or Metabolic bone disease. 4. Sulphasalazine. 5. Tuberculosis, Hepatitis B, Congestive Heart Failure.


Services and ProductsPharmaSource is Ireland’s leadingsupplier of unlicensed medicines.

PharmaSource can help reducethe valuable time our customersare spending searching formedicines that are currently inshort supply or discontinued in thenational market. We can sourcethese products for you.

PharmaSource supply ourcustomers with an extensive rangeof manufactured specials includingliquids to meet the needs ofgeriatric and paediatric patientswith unique swallowingrequirements.

PharmaSource supply a range ofcreams, ointments, gels, powders,suppositories, tablets and capsulestailored to the unique needs ofyour patients.

PharmaSource have anunparalleled range of products instock including cold chain andcontrolled drugs. We haveimmediate access to a database ofmore than 1 million medicinesworldwide all of which can beeasily ordered via our website.

PharmaSource have expertisein logistics, national andinternational regulatory affairs,HSE reimbursementpolicies and qualitycontrol.

Why partner with PharmaSourceWe are an Irish company with acombined history of serving Irishpharmacies since 2006.

We offer a tried and tested service youcan rely on. The Pharmasource team ismade up of qualified pharmacists andtechnicians who understand theimportance of delivering your order ontime every time to meet the needs ofyour valued patients.

Market leading price structures.

Multichannel ordering options: Via ourwebsite, fax or email makes placingyour order very easy.

The majority of customer orders aredispatched with their next scheduleddelivery*.

Contact details:

4045 Kingswood Road,

Citywest Business Park, Co. Dublin.

Free Phone: 1800 440 440

Free Fax: 1800 441 441

Email: [email protected]

Web: www.uniphar.ie

Pharmasource is a division of the Uniphar Group.*In some cases products that are difficult to source may take longer, please call 1800 440 440 for more information.

Formerly known as:

Pharmasource_IPU_Ad (A4) Print:Layout 1 1/22/14 3:09 PM Page 1

PROFESSIONAL Dr Catherine Conlon

HSE Crisis Pregnancy Programme Research on fertility, motherhood and sexual health services issues for Migrant Women in Ireland

The HSE Crisis Pregnancy Programme is launching a Summary of

Research with Young Migrant Women on Sex, Fertility and Motherhood. The summary draws from a qualitative study comprising research interviews with young women from three migrant communities: Chinese, Polish and Nigerian, as well as young women from the Muslim faith community. The qualitative study involved in-depth interviews with a total of 81 young migrant and minority ethnic women aged 18-30 participating in one-to-one interviews (N=26), friendship pair interviews (N=4) and nine focus group interviews (N=51). The analysis explores the meanings these young women bring to their sexual relationships, sexual health, and reproductive healthcare decisions, including contraceptive use, pregnancy and motherhood.

The research shows that while migrant women share many perspectives with Irish women in how they feel about fertility, sex and motherhood, there are some important differences in how

each negotiates their sexual lives. Perceiving responsibility for sexual morality as vested principally in girls and women is a key site of commonality, though with cultural nuances.

Findings of this research show that migration and transition to a new cultural environment can involve encountering opposing meanings attaching to relationships and sexuality in one’s culture of origin and the new, host culture. Women from each of the diverse national, cultural and ethnic backgrounds represented in the study describe an association of fear, shame and guilt with sex and pregnancy before marriage in the cultural messages they receive from home. Women in the study perceive Ireland as ‘westernised’ and representative of more permissive attitudes towards sexuality than their cultures of origin. They encounter conflicting messages about appropriate sexual behaviour for young women as they move between their culture of origin and Irish ‘westernised’ culture and as they navigate between the various realms in their lives - home, school and peer group.

In this article, Dr Catherine Conlon, PI Research with Parents Project, School of Social Work and Social Policy, Trinity College Dublin, reports that pharmacies are a key contact for young migrant women seeking Sexual and Reproductive Health services.

34 IPUREVIEW JUNE 2014

Migration involves certain expectations and pressures to succeed. Women in the study describe how the meaning of migration is usually as an opportunity to ‘better’ oneself. Migrant families can feel the expectations of those ‘back home’ on them to progress placing particular pressures on the next generation to succeed. For migrant families, a young, unmarried daughter becoming pregnant signals a failure to optimise enhanced educational opportunities in the new country of residence. It also signals a failure by her family to maintain the moral standards of their home country of origin. Young migrant women consider that respectability of not just the girl but also her family and her wider community depends on a young woman’s sexual propriety. These factors create particular conditions for a pregnancy to be construed as a ‘crisis’.

There were high levels of variation in the knowledge and experiences migrant women had of sexual and reproductive health services in Ireland. Findings show low levels of familiarity and connectedness with Crisis Pregnancy Support Services (CPSS) among young migrant women in this study. Within the primary care landscape, women in the study more often cited pharmacies as a key point of contact for information and advice on health issues. The much higher reliance on pharmacy services over other primary healthcare settings means pharmacies have the potential to play a key role in connecting young migrant women with Crisis Pregnancy Support Services and other sexual and reproductive health services. Heightened awareness among community pharmacists of migrant women’s patterns of use of primary care services highlights the key role they can play in connecting migrant women with sexual and reproductive health services including CPSS.

Women’s knowledge of and use of health services differed according to whether they had come to Ireland as part of a family

or had come independently. Young women migrating independently report low levels of engagement with Irish health services including GPs due to language issues and limited knowledge of services and pathways to access services. Within the study group, more Muslim and Nigerian women were second-generation migrants and were more likely to be integrated into the Irish health system, e.g. registered with a GP, through their families. Yet, for these young women cultural silences and a sense of shame in relation to sexuality inhibits them asking a GP about sexual health services. Given that GP services often act as an important point of contact and information for sexual and reproductive health services, including crisis pregnancy support services (CPSS), migrant women are missing out on these opportunities to connect with services.

Women migrating independently who retain strong links to their home country describe engaging in ‘transnational’ health service usage. This involves returning home for healthcare. Reasons for doing so include perceived high cost of GP services in Ireland while factors facilitating returning home include familiarity with services, lack of language barrier and preferences of approaches taken. Women are sourcing contraceptive products from

pharmacies and doctors in their home countries, sometimes ‘bulk buying’ to try to ensure they have what they need until their next visit home. Some women also use websites as means to source contraceptives. Polish women also operated outside of the Irish health system by attending Polish clinics operating in Ireland. Transnational health service use often results in migrant women establishing no contact with local Pharmacy, GP or sexual and reproductive health services. This leaves them at risk of being unable to avail of such supports and services locally and quickly if the need arose.

Another factor inhibiting migrant women’s contact with SRH services is the development of ‘localised’ terminology in this area in Ireland, such as ‘crisis pregnancy’ or ‘positive options’. Such service terms and titles are only understood through local ‘tacit knowledge’ acquired over time, which is unavailable to those recently arrived here. Accounts of women who did experience a crisis pregnancy illustrate lack of knowledge about crisis pregnancy support services, leaving them more isolated and reliant on personal networks, particularly parents.

The study findings provide an important direction for service providers and policymakers in terms of making sure migrant women know the services

that are available to them and ensuring that women experience culturally-sensitive care when they access any part of the healthcare system. Heightened awareness among community pharmacists of migrant women’s patterns of use of primary care services and reliance on pharmacies over other areas of the primary care landscape highlights the key role they can play in connecting migrant women with sexual and reproductive health services including CPSS.

The HSE has developed resources such as the HSE Intercultural Guide which provides practical information to health and social care providers on culturally appropriate healthcare. The Positive Options website, www.Positiveoptions.ie, listing State-funded crisis pregnancy services includes multilingual information to which women for whom language is a barrier can be referred. Being knowledgeable about sexual and reproductive health and Crisis Pregnancy Support Services, displaying related information leaflets prominently and directing women to further resources and services that are available locally and free of charge while emphasising their confidential, supportive approach represent key actions Community Pharmacists can take.

In presenting these findings, we are mindful of the diversity represented within migrant communities meaning issues highlighted here will not be experienced in the same way by all migrant women. The purpose of the research is to help build multi-cultural competency in this area among sexual and reproductive health policymakers and service providers including Community Pharmacies in recognition of our multi-cultural society.

The research summary discussed here will be available soon at: www.crisispregnancy.ie/research-policy/research-summaries/ and printed versions will be available to order from www.healthpromotion.ie.

“ Within the primary care landscape, women in the study more often cited pharmacies as a key point of contact for information and advice on health issues.”


Launching at United Drug Tradeshow - MediStori A unique Medicine Management System to help the community pharmacist retain customer loyalty, save time, promote medication adherence and offer an extra retail margin.

PROFESSIONAL

Mother of three Olive O’Connor is on the cusp of revolutionising

how people store and manage their medication and medical documents. The Dublin native, who moved to Mayo when she was 16, has created a personal medical organiser that keeps all of a person’s, or family’s, complete medical records together in one place, along with keeping track of a person’s medication. Olive told the IPU Review that the personal organiser can be ‘an essential tool in an

emergency situation’. Olive’s three daughters, aged 11, 10 and seven, all have chronic illnesses, including heart conditions and autoimmune disorders and, while over the years she had always just about managed her children’s various appointments, she only realised the stresses of managing illnesses when her father came out of hospital last year on 22 medications.

Their local pharmacist was extremely helpful with regards advice about these medications and was able to offer the simple solution of pill boxing. But there was

one problem – many of her dad’s medications were not pills – there were inhalers, gels, liquids, injections and pain patches and these could not be stored in a pillbox. His pharmacist was dismayed that they could not offer any other help, so Olive went and made a little diary for them to log the reasons he was taking his medications and the times he took them. It was only when her dad collapsed a month after his discharge that Olive saw the true value in what she had designed. The paramedics looking after her father on the scene said that

it was an invaluable tool as not only could they see his full list of medications and the last time he had taken them, they could also ring the hospital ahead with his chart numbers and diagnosis, so the A&E staff were prepared for him. They said it was so difficult to try and access apps in phones and get the correct information and also that A&E staff spend hours each day ringing pharmacists for information on medications.

Taking this on board, the former youth worker took the plunge to develop the product herself, running


patient and carer focus groups and surveys and speaking to various pharmacies, whose feedback was extremely positive. Olive herself knew the true value in her pharmacist as a key health practitioner as she would regularly go there, even before visits to her GP. Pharmaceutical technicians and over-the-counter staff told Olive how they were asked their opinion regularly by customers on health and medication management and that they would love to have a solution to help them.

Bernard Duggan, a member of the IPU’s Executive Committee, said, “Community pharmacists support their patients on a daily basis in managing their complicated medication regimens. They ensure that they take their medications as prescribed and provide patients with advice and information on these medications. The MediStori is an innovative tool, which assists patients to manage their medication safely

in conjunction with their Community Pharmacist.” On top of this, Stephen McMahon, CEO of the Irish Patients’ Association, has called the MediStori a ‘patient safety initiative’ and he chose Olive to be part of the Clinton Global Initiative, where she was video interviewed about her experiences as a carer and about how she developed the MediStori to help patients, parents and carers alike. This video of her and the MediStori will be broadcasted globally through the CGI’s own website. The Carers’

Association also gave valuable advice and support and told Olive that, “The MediStori is an invaluable tool to help carers keep their loved ones medical information together in one unit and to have their most accurate and up-to-date information, easily accessed at any one time, by any of the healthcare providers associated with that person. It offers carers a simple yet effective solution to help manage all aspects of one’s health, which in turn can increase patient safety and give the carer peace of mind.

The MediStori is not just another product on the shelf. It is an invaluable tool in which the pharmacy can offer their customers a real solution to real problems, it can help build on customer loyalty, it can help reduce risks and responsibilities for their customer, it can promote medication adherence, it can save time and money and it can offer a unique retail opportunity in the medication management area.

Launching the MediStori at United Drug’s tradeshow in the Aviva Stadium in June will allow pharmacies nationwide to order the MediStori Folders and the Medicine Memos, which will allow customers have immediate access to it. Please feel free to contact Olive and her team if you would like to set up a meeting in advance on 087 7982232 or visit www.medistori.com to see her short introductory video and information about the MediStori.

“ MediStori offers carers a simple yet effective solution to help manage all aspects of one’s health, which in turn can increase patient safety and give the carer peace of mind.”

Our new look Link guide is now available.

To join contact your Uniphar Representative.Details available on www.unipharcontact.ieOpen to ALL Community Pharmacies.

Not a memberof Link?

LINK-banner-ad.qxp_Layout 1 16/05/2014 16:57 Page 1


IPU Business Training Academy

IPU/ILM Diploma in Leadership and Management

• Are you a pharmacist, technician or member of a pharmacy team in a supervisory or managerial role?

• Are you planning to be in a supervisory or managerial role in the future?• Are you serious about developing your Leadership and Management capabilities?• Are you in a supervisory or managerial role without any formal qualification?

If you answered ‘yes’ to one ormore of the questions above,would an accredited BusinessDiploma in Leadership andManagement assist you?

The IPU/ILM Diploma in Leadershipand Management Course is…• Highly interactive

part-time course• Delivered over 24 months• One face-to-face workshop

each month• Comprehensive on-line resources

are available

Institute ofLeadership &Management

Commencing September 2014

IPU Diploma 2pp A4 15/05/2014 12:15 Page 1

IPU/ILM Diploma in Leadership and Management

• Understanding Leadership

• Developing your Leadership Styles

• Leading and Motivating a Team Effectively

• Planning and Allocating Work

• Improving the Performance of the Work Team

• Developing People in the Workplace

• Understanding Discipline in the Workplace

• Understanding Conflict Management in the Workplace

• Workplace Communication

• Understanding Recruitment and Selection of New Staff in the Workplace

• Understanding Customer Service Standards and Requirements

• Effectively Selling to Customers

• Understanding Marketing for Managers

• Understanding Financial Management

• Understanding Costs and Budgets in the Organisation

• Understanding Health and Safety in the Workplace

• Understanding Security Measures in the Workplace

• Building Awareness of Waste Management

• Solving Problems and Making Decisions

• Managing Workplace Projects

Course Assessment, Qualification & Progression

Student assessment includes assignments, knowledge and reflective reviews, oral presentations and writtenreports. In addition, a number of study hours and reading is also required. Whilst studying with ILM,students can enjoy membership access to the ILM on-line resources for students.

In demonstrating the necessary knowledge, understanding, competence and achievement of assessmentrequirements, students will be awarded an ILM Level 3 Diploma in Leadership & Management, which isequivalent to a Level 5 on the Irish National Framework of Qualifications (NFQ).

This course has been specifically tailored to meet the development needs of members and their employees.Its focus will be on the Irish Pharmacy Sector. Case studies, discussions, presentations and classroomactivities etc., will all guide learners to maximise and apply their newly attained knowledge and skillswithin the workplace.

Entry Requirements & Fees

There are no formal entry requirements but participants will normally be either practising or aspiringsupervisors or managers with the opportunity to meet the assessment demands and have a background that will enable them to benefit from the programme. The fee per person is €2,495. (Non-membership fee is €3,995).

For further information contact:

Darren Kelly - 01 4936 401 or [email protected] McManus - 01 4936 401 or [email protected] www.ipu.ie - Training & HR, Business Training

Course Contents

IPU Diploma 2pp A4 15/05/2014 12:15 Page 2

Where we are now: The current marketIn recent years, the retail pharmacy sector has undergone a period of significant change, upheaval and uncertainty with the introduction of FEMPI and Reference Pricing and the profitability dynamic of the sector is changing dramatically. These, together with the economic climate and the availability of finance, have acted as a deterrent within the market for completion of transactions of retail pharmacies in the last six years.

As many of these measures have now been introduced and the impact on current trading results now, at least, can be measured, which will reduce the level of uncertainty.

This is paving the way for stabilised earnings, which may result in effective budgeting and appropriate projections. The Irish Banking sector has also become more stable with the pillar Banks now making funds available to further support and fund SMEs in a bid to return to their core business activities.

So the real question is: what does this actually mean for the retail pharmacist?

There is an expectation that the market for retail pharmacies will become active once again. As owner pharmacists look to retire, operators undergo fundamental restructures that could involve disposal of outlets and a period of consolidation is likely to occur, with some opportunities also for new entrants to come into the market.

The number of transactions in recent years has been extremely limited; therefore, how can the market value of a pharmacy be determined? Historically, pharmacies had been valued based on a multiple of net sales or turnover. This multiple was determined by the size and location of the outlet. This is no longer deemed an appropriate method of valuation as turnover does not equal profit. It may be argued that, historically, pharmacies have been overvalued and, in some instances, the underlying business has not been as strong as anticipated and it has been unable to support the level of related debt. Current valuation methods are based on profitability rather than volume.

In this, the first article in a ‘Now & Next’ series, Edel Dempsey, Corporate Finance Consultant with Baker Tilly Ryan Glennon, looks at the issues surrounding buying and selling pharmacies in the current market.

Now & Next: Buying & Selling Now

BUSINESS Edel Dempsey


Step 1 Maintainable Earning €450k

Step 2 Underlying Multiple x 5

€2,250k

Step 3 Add Net Current Assets €50k

Step 4 Less Debt (€1,000k)

Valuation €1,300k

The standard model can be broken down into four steps:

n Step 1 Establish Maintainable Earnings, these are Earnings Before Interest, Tax, Depreciation & Amortisation; i.e. Net Profits, say €450k.

n Step 2 Determine a Multiple, the number of years it will take the business to pay for itself, say five.

n Step 3 Add Net Current Assets; Current Assets (e.g. Debtors & Cash) Less Current Liabilities (e.g. Creditors), say €50k.

n Step 4 Less Debt, say €1,000k.

The application of this valuation method appears relatively straightforward; however, like all formulae, it remains exposed to interpretation and adjustment. While the fundamental principal of valuation still applies, i.e. ‘something is only worth what someone is willing to pay for it’ the starting positions of a buyer and seller in any deal are likely to be very different. This can, in part, be attributed to the adjustments made to maintainable earnings to reflect:

n The full impact of Reference Pricing.

n Any adjustment to allow for changes to the level of Director’s Remuneration.

n Any adjustments to rent payable.

n Any other factors that may be appropriate to the given outlet.

The challenge will always remain: how can we offer comfort in relation to this? The seller will try to maximise the price, while the buyer will look to keep it as low as possible. The comfort is in the numbers, the trading results and projections. The uncertainty is in the assumptions relied upon and their application to the numbers. This can be further simplified through the identification of the two key variables:

n Maintainable Earnings: This figure is usually subject to adjustment in a bid to arrive at an appropriate figure to reflect future operations. Uncertainty regarding the impact of FEMPI and Reference Pricing has cast a shadow over how this may be calculated in recent years. However, with many of these measures now introduced and with current results experienced being in line with expectations, there is now a clearer line of sight as to where the

market is expected to be in the coming years. The most significant indicator of future maintainable earnings will be derived from an analysis of the sales mix for each individual outlet.

n The Multiple This can prove more difficult to be arrived at and is influenced by factors both specific to the outlet and the market as a whole. The concept of the multiplier is derived from the Price Earnings Ratio (i.e. Price per Share divided by Earnings), which is readily available for publicly quoted companies where shares are regularly traded. However, this cannot be applied as easily to privately owned companies and sole traders. Factors for consideration would include: the size of the operation, whether it is a single outlet or a multiple and a discount on P/E Ratios achievable for public companies must be applied to address their lack of marketability and particularly where the transaction may be identified as a distressed sale. This multiple will also take into account the investment requirements of the parties.

As mentioned earlier, in times gone by, pharmacies were valued as a multiple of turnover or net sales. When one examines some of these transactions, many appear to have been at multiples in excess of 8-10

times maintainable earnings. Although the number of transactions in recent years has been very low, looking at the transactions we are aware of, a multiple of 4-5 times maintainable earnings seems more appropriate but any valuation may be influenced by varying factors and, as such, the number arrived at will differ, sometimes significantly, on a case-by-case basis. There is no overall ‘one fits all’ multiple.

In the current environment, a key factor in the completion of any transaction is the position of either party with the Bank. Whether the outlet has been placed on the market for sale at the request of the Bank or whether they are providing part of the finance for the buyer will have a significant bearing on the transaction price as it will impact on the strength of either party.

In the end, the sale or purchase of a pharmacy is a negotiation. The range of values established form the starting positions of the parties where the ‘valuation’ or sales price is determined by the factors affecting each individual outlet. The impact of such factors can either be heightened or mitigated by the strength of the argument presented by the negotiation team (usually the accountants and solicitors) of either party so as to bring the transaction price closer to where the parties want it to be.

If you require further information on any of the details contained in this article, please contact Edel Dempsey, Corporate Finance Consultant at Baker Tilly Ryan Glennon, on 01 496 5388 or email [email protected].

“ The seller will try to maximise the price, while the buyer will look to keep it as low as possible. The comfort is in the numbers, the trading results and projections.”


With the latest set of cuts to your dispensary income, a bespoke retail review of your front-of-pharmacy will give your pharmacy a facelift to boost your sales without overstretching your budget.

Our One-Day Review will include:

■ Expert advice on your retail offering

■ A complete review of the front-of-pharmacy including category management and promotion planning

■ Providing training in sales techniques

■ Re-merchandising displays (interior and window) to enhance the retail experience in your pharmacy

■ Helping you and your sales team develop new sales ideas

■ Using key performance indicators to help you increase front-of-pharmacy business

■ Motivating your sales team to be innovative, sales focused and up to speed on product knowledge

Darren Kelly, IPU Business Development Manager, has almost 20 years ofretail experience.

If you would like further information on this service or would like to book a Retail Review, please contact Darren on (01) 493 6401 / 086 028 9825 /

email: [email protected]

Tailor-made just for your pharmacy

How we helped one pharmacist...

The idea that the IPU could offer me a retail expert to

come to my pharmacy and help me to get the “retail” factor into a pharmacy that has massive competition from two retail multiples was a great idea.

Oonagh O’Hagan, Meaghers Pharmacy Group

IPU Retail A4 Ad TAILOR POST-CONF ART.indd 1 26/05/2014 21:35

Many books have been written about customer service, what we should all do and how we should do it. I recently read Raving Fans: A Revolutionary Approach to Customer Service by Ken Blanchard and Sheldon Bowles, which gives a really interesting approach to customer service. You feel that you offer good customer service but are these customers “raving” about you to other customers?

Are your customers “raving” about your customer service?

BUSINESS Darren Kelly, IPU Business Development Manager

Satisfied customers just aren’t good enough; you need to be making the extra steps to have your

customers rave about your business, to tell others about the difference you make. In this issue, Darren Kelly, IPU Business Development Manager, gives you an overview of ways to measure the level of customer service offered in your pharmacy.

Customer service is a major part of customer retention. How do you know if your pharmacy is offering good customer service? It is not as ingenuous a question as it appears. Many businesses have no real idea if they provide good customer service. Many businesses feel they do

because they don’t get a lot of customer complaints. The number of complaints about customer service is a good measure for bad customer service but complaints are a completely inadequate measure for good customer service.

There are lots of customers who aren’t going to complain, even if they come into your pharmacy and are treated poorly. These customers will just walk away and not come back, probably telling several other people what a bad customer service experience your pharmacy provided.

If you don’t give your customers some good reasons to stay, your competitors will give them reasons to leave.

43IPUREVIEW JUNE 2014

Where does customer service begin?Customer service starts from outside your pharmacy. How the pharmacy looks – from the window displays and posters on doors to the lighting inside the pharmacy – start the whole ‘experience’ for the customer. If your window displays are good, bright and inviting, the customer is expecting the same consistent feeling when they enter the pharmacy.

It is imperative that a customer is at least acknowledged in the first 2-3 seconds that they enter the pharmacy. It doesn’t have to be a straight “can I help you” or “are you OK” but should be a simple “Good Morning”. Too many times I have witnessed customers enter a pharmacy, walk around the pharmacy and no member of staff engages with the customer. This is business suicide.

A consistent service offering from entry to exit is fundamental in retaining and gaining, new customers.

Think about why you shop in certain shops. They may be a little bit more expensive, they may not, but it is the greeting and the way you are made to feel while you are in that store that makes you return.

How good is your pharmacy Customer Service?To find out if your pharmacy is providing the kind of customer service that you want to provide to your customers, you need to get some outside views. Staff members’ views on customer service expectations will give you an insight but their views can be coloured from their personal points of view or previous customer service expectations.

To properly measure the success of your customer service, you need to get the views of your customers and your potential customers. This is paramount in ensuring that you are aware of your customer’s needs, what you are doing wrong and how it can be done better and, ultimately, what you are doing right.

But how can you find out what a customer thought of your customer service? There are a number of ways that you can investigate your customer service. They are:

1. Mystery Shoppers Mystery shoppers have been used for many years in all aspects of retail; their job is to pose as normal customers and report back to you about the experience that your customers get when they shop in your pharmacy. If you utilise the services of a mystery shopper, be sure that they are clear about exactly what you want them to investigate and report the findings.

2. Ask your customers directly Another tried and trusted method of finding out how your customer service measures up is to survey your customers directly for their opinions. One way is to ask customers to complete a questionnaire about their most recent customer service experience in your pharmacy. You can encourage customers to fill out a questionnaire by running a prize draw in the pharmacy or, if you have a loyalty scheme, rewards against their next purchase.

Surveys and questionnaires are an excellent source of information, but remember that personal conversations with your customers can also be revealing. When you are in the pharmacy, engage the customer in a conversation about the level of customer service they experienced. All customer service research doesn’t have to be formal, ad-hoc conversations can be useful sources of information too.

On a separate note, how many of you can relate to you or your staff telling customers to come back in 10 or 15 minutes for their prescription. This is a real ‘no-no’. Think about what you have done. You have greeted the customer politely, welcomed them into the pharmacy;

and then told them to “get out” of your pharmacy, albeit politely, for 15 minutes as you don’t want them ‘hanging around’ the dispensary counter. Ultimately, where this happens the customer will come back with some products that they could have purchased from your pharmacy. If a customer’s prescription will take some time, offer them a seat, a newspaper or invite them to ‘trade’ in your pharmacy. Customers are used to this type of conversation so don’t think they will feel a hard sell coming on. Let them browse your pharmacy and once you have the flow of the pharmacy correct, along with signage to highlight the value available in your pharmacy, you will see an increase in impulse purchases.

Let those extra eyes be your customer service guideOnce you know what customer service in your pharmacy is truly like, as your customers see it, you will be equipped to improve it.

Complaints are a great starting point for improving on bad customer service, but if you want to provide good customer service you must go beyond listening to complaints and responding to them. Once you find out what your customers are truly thinking, your aim for your business is to provide the kind of customer service that will retain and develop your business.

Lead from the frontIt is imperative that all your staff (not just the counter/sales staff) buy into good customer service; it is a must that you as the owner/pharmacist lead your team from the front, meeting and greeting your customers. The success of your business can rest with the opinions of customers in your area. Be the pharmacy that people are talking about in positive terms towards the service they receive in your pharmacy.

RetentionCustomer retention is not only a cost-effective and profitable business strategy, but in today’s business world, it’s necessary. This is especially true when statistics tell us that 80% of your sales come from 20% of your customer base.

In years past, the importance on customer retention was not as important, loyalty came naturally. People shopped in their local neighbourhood shops and pharmacies. Customers had a personal connection with the pharmacist and their team. This has changed somewhat over the last number of years. Pharmacies are now larger, situated in large shopping centres and retail outlets. The rural pharmacy has an advantage over the city pharmacy as many of their customers have been with them forever. But now that there is such a vast amount of pharmacies, the convenience factor to customers will play a big part in customer loyalty.

If you need any further information relating to the article or just need some retail pharmacy advice, contact Darren in Butterfield House on 01 4936401 or [email protected].

Raving Fans: A Revolutionary Approach to Customer Service is available from the IPU Bookstore on www.ipu.ie.


Just over 12 months since its introduction, the IPU Group Home Insurance scheme continues to deliver

real savings for IPU members, without sacrificing important cover.

It can be easily assumed that all home insurance is the same, but that is not the case and quite often that lesson is only learnt when a claim occurs. The IPU Home Insurance group policy includes a number of extra benefits that provide additional peace of mind at a time when weather patterns

are so unpredictable.One such unique benefit

is ‘Full No Claims Bonus Protection’. You may be familiar with this cover on your private motor policy, but now it is available on your Home Insurance policy too. This benefit is completely exclusive and only available through the IPU Group scheme arranged by Halligan Insurances, enabling IPU members to protect their valuable no claims discount should you unfortunately have to make a claim.

With over 30 additional benefits included in the policy,

tailored specifically for IPU members, this comprehensive cover-all comes at an extremely competitive premium as a result of the IPU, taking advantage of their numerical strength, having negotiated a substantial scheme discount.

With an instant online home insurance quotation available on www.ipu.ie, it means that all IPU members can avail of a no-obligation quote when their renewal falls due.

We’re delighted that eight out of 10* IPU members proceed with the quotation

received under the scheme, proving that this IPU member benefit has become another great service the IPU offers its members.

IPU group Home Insurance scheme is arranged by Halligan Insurances. Home insurance quotes are available on www.ipu.ie or by phone at 01 8797100.

Halligan Life & Pensions Ltd t/a Halligan Insurances is regulated by the Central Bank of Ireland.

*Figures based from 1/04/2013 to 1/5/2014.

Brian Halligan, insurance consultant, explains why IPU members should consider the IPU Home Insurance scheme when looking for savings on their Home Insurance Renewal.

What makes IPU Group Home Insurance different?

BUSINESS


At a time when savings accounts are offering practically no returns, it’s not surprising that savers and investors are looking elsewhere and readers may be surprised to learn that investors who invested in Irish equity managed funds more than doubled their money in the last five years.

Of course, the key reason was that five years ago Irish shares suffered badly from the

economic collapse. What is more remarkable is that these returns were achieved despite the performance of the banks in the initial for most of that period.

So it is likely that only the bravest of investors

would have celebrated the 106% Irish equity managed fund growth seen in the five years to the end of April last. Understandably, most investors, especially those that were burned by the bank shares, would be reluctant to invest in an Irish equity fund, considering the fiscal and taxation drag on Irish economic recovery. But Irish equity funds are not really

a play on the Irish economy because a number of the shares are in companies such as Ryanair and CRH, whose overseas profits are the key to the growth of the Index of Irish equity funds. Their growth continued into the 12 months to the end of April. Among the top performing funds in the sector was New Ireland Irish Equity, up 35.6% in the 12 months and almost

11% in the first four months of this year. Similar growth was seen this year at two funds managed by Bank of Ireland.

The worst fund in the Irish equity sector, Ulster Bank Secure Iseq 3G, managed to grow by only 10.8% over the 12 months, but that is still way better than the returns achieved from deposit accounts.

Investment funds outperform deposits

BUSINESS Donal Buckley, freelance journalist


“For those who want to lock-in their profits at a time of uncertainty, the choice of funds can range between bond funds, money market funds or managed defensive funds. ”

Another sector to perform well over the five years was North American Equity, which rose 96.5%. During the most recent 12 month period one of this sector’s best performers was VAM Funds US Microcap Growth, which rose 27%. However, since the start of the current year, some concerns about the sustainability of this growth, as well as fears that the US Government may increase interest rates, has led to some profit taking among some US equities and, as a result, the growth of this sector has slowed. Investors in UK equity funds have also seen good returns - up 88% during the five years. Over the most recent period the best performing fund in the sector was the Bank of Ireland FTSE 100 fund, which rose 2.48% against a sector average of

0.89% in the four months. After such strong growth,

investors are understandably cautious about prospects that it can be sustained. Those concerns are not helped by uncertainty about the prospects for growth in some emerging and European economies, as well as concerns about the Ukrainian/Russian situation.

One way for investors to hedge against those concerns is to switch funds into less risky funds, such as the managed balanced funds. Over the five years these showed average growth of 54%. Those with balanced funds with more than 65% of their investments in equities also managed to achieve an average growth of 2.65% over the first four months of this year when New Ireland’s

Income and Growth fund rose by 5.25%.

Many fund management companies allow an investor to switch within a portfolio of funds ranging from the risky to the cautious and often at no extra cost. For those who want to lock-in their profits at a time of uncertainty, the choice of funds can range between bond funds, money market funds or managed defensive funds. Two of the Irish Life funds in this sector achieved 5% growth in the first four months of this year.

Government bond funds achieved 22% growth over five years, due mainly to improvements in government finances. Among the better performing funds in this sector this year were Zurich Life’s Long Bond fund, up 9.8% and Standard Life’s Fixed

Interest fund, up 6.9% over four months.

Fund managers will charge management fees and, in some cases, entry or exit commissions of up to 5% and the funds are also liable for a DIRT tax equivalent of 33%.

Furthermore, as these funds can fall as well as rise and past performance is no guarantee of future performance, investors need to take a five-year view on such investments. They are also advised to seek professional advice on both their own personal financial position as well as on the shares in which these funds invest before deciding on their suitability.

Donal Buckley is a freelance journalist.

We can help...

227548-DPS-MEDISOURCE-AMA-IHCA.indd 2 05/09/2013 12:17:14Medisource Ad Sept 2013.indd 1 06/09/2013 10:06:11

Are there medicinescurrently unavailable to your patient in Ireland?

www.medisource.ie | Call 1-890 2866366 | Fax 01 2866288 | Email [email protected]


In the May edition, we looked at the relevant Epos reports you should use to help you buy more effectively for the Christmas season. This month, we are going to focus on staff training and mistake making.

Your Epos solution is at the heart of your business. It tracks all stock movement,

comprehensively analyses all transactional data and records all the monies that pass through your business. Therefore, it is imperative that all users know how to operate your system correctly. If mistakes are made, this can create a lot of work for the person tasked with uncovering the error. Worse still, if the mistake goes unnoticed your sales figures may be incorrect and your stock levels gone astray.

The quality of the information you use to base your decisions on is only as good as the information that has been entered onto the system. For example, if some staff members consistently sell items through department open keys instead of scanning them, you are missing out on being able to report on a

wealth of information about that product. By scanning the item, the selling price is accurate, the margin is accurate, the VAT has been calculated correctly, the money has been accounted for in the drawer etc. Also, it is faster to scan the item than to key in the sale amount and select the (relevant) department. Thirdly, the customer can easily see that their purchases are being recorded accurately and that they are, for example, benefiting from the special offers available on those items. Bad habits that have crept in over the years must be identified and eliminated. Ask yourself, do you see regular discrepancies between the sales and cash drawer reports? Are there excessive voids? Do you feel that staff are adequately trained to use your Epos solution to its maximum? If the answer is ‘no’, then it may be beneficial to implement a structured training plan.

BUSINESS Enda Harte, Sales & Marketing Manager, JustScan Ltd

Staff training and mistake making


Contact Eileen BrowneE: [email protected] T: 087 6869132

www.barrypackaging.com

See you at the United Drug Pharmacy Showin the Aviva Stadium, Dublin 8th, 9th and 10th June.

Steps to improve Epos skills1. Have a meeting with staff

or have an informal chat with each member and ask them if there is any area they need more training on to help them do their job better. Find out if your staff are all confident that they know how to use the Epos solution for the tasks that are required of them. Identify the areas your staff need to improve on, or areas that cause confusion amongst staff, e.g. deposits.

2. Once you know what needs to improve, set about training the staff on these aspects of the solution. Group the areas of training together and schedule time out for the staff to receive that training in a non-disruptive environment. Remember, a good way to reinforce training is repetition, e.g. if you have trained a staff member how to use the credit account facility, perhaps ask them to do all the credit account transactions in the pharmacy for the rest of the day. This gives them a chance to practice what they have been shown.

3. It would be very beneficial if your most senior staff member felt competent enough to undertake the training. If not, ask them to initially refer to the Epos manual or alternatively, call the Epos supplier who can dial in remotely and talk them through each function

over the phone. If there are a lot of areas to be covered, perhaps a structured training session from your supplier might be the most worthwhile option.

Common mistakes and how to fix themMistakes happen. We are all human and, unfortunately, one incorrect key press and there will be repercussions. For example, a customer is paying for their transaction by Visa Debit card, but out of habit the staff member selects the cash button. This will mean that when you try to balance your cash drawer at the end of the day, your figures will not tally. If this happens only once in a day, the mistake will easily show up. However, if a few staff members make that same mistake that day, there were also some transactions with cash back and others with multiple tenders, then the job of cashing up at the end of the day becomes very cumbersome. To combat this, you must reiterate to the staff the importance of always selecting the correct tender. In this example, remember it is always an option to integrate the Credit Card function. This means that the only way a card payment can be selected as the tender, is if it is presented and authorised on the pin-pad which is connected to the till.

When a mistake is made, it can be easily rectified. The simplest way to undo a mistake is to do the opposite. Some examples include:

1. If staff press cash instead of Visa Debit at the end of a transaction. Refund the transaction completely and select cash as the tender. Ring through the sale again and this time select the correct tender of Visa Debit. This will correct your Cash Drawer report and will help ensure that your till balances.

2. If a staff member receives in too many of a product into stock by mistake; e.g. received in 100 of product A instead of 10. This means you have 90 too many of product A. You simply need to return the 90 of that product, which will correct your stock level.

3. Staff put through a transaction on the credit card machine and just put the slip into the drawer forgetting to ring up the sale on the till. This kind of mistake shows up on the end-of-day report when you have too many credit card receipts. If you find that you are missing one or more sales, you must ring them through and then run your cash drawer report again.

Training New StaffIt is important to have a procedure in place for training new members of staff. A document should be drawn up for the trainer to use with a list of the functions they must explain and show to the new staff member. Ticking everything on the list will

ensure that the new staff member is competent in the operation of the Epos Solution. Ideally, one senior staff member should be responsible for all of the Epos training for consistency reasons.

When staff leaveWhen a staff member leaves, it is important to fully document exactly what Epos functions they were responsible for. These functions need to be explained and reassigned to another staff member. Ideally, the departing staff member should be allocated the time to train their replacement over as long a period as possible as there may be monthly tasks included. This will ensure that certain aspects of your operation do not fall down.

While training can be time consuming initially, it always pays off to have properly trained staff. The information in your Epos solution must be accurate and all mistakes should be corrected in a timely fashion. Remember, the information that comes out of your system is only as accurate as the information that has been entered into it.

Enda Harte is Sales & Marketing Manager with JustScan Ltd who develop and sell their own Epos solution, PharmEpos. PharmEpos has been tailored for the specific needs of the Irish pharmacist. For more information or a free consultation, contact Enda on 071-9130488 or visit www.justscan.ie.


Problems posed by the shortage of certain medicines and ways and means of overcoming this, and the need for an Early Access to Medicines Scheme were among the issues raised in questions to the Minister for Health in the Dáil recently. The circumstances where pharmacists may prepare medicines for their patients, when an authorised version of the product is not available, were also explored.

Problems of dealing with shortages and unavailability of medicines raised in the Dáil

Medicinal Products AvailabilityMedicines shortages have become increasingly prevalent in recent years and off-label use and use of unlicensed medicines, are two of a number of strategies used to ensure that the needs of patients are met. At EU level, initiatives have been put in place to promote the development of orphan (treatment of rare medical conditions) and paediatric medicines to address unmet need in those areas. This was stated by the Minister of State for Health, Deputy Alex White (Labour, Dublin South) in reply to recent Dáil Questions from the Fianna Fáil Health Spokesperson, Deputy Billy Kelleher (Cork North-Central).

Deputy Kelleher had asked if there was a definitive list of areas of unmet medical need in terms of medicines either off-label or unlicensed and if the Minister would consider compiling such a list.

The Minister of State said it was not possible to identify unmet needs in terms of off-label and unauthorised medicines. “Under European and Irish legislation, medicines must be authorised (licensed) before being placed on the market. The legislation provides that a medical practitioner may prescribe an unlicensed medicine for use by an individual patient

under his direct personal responsibility. Off-label use of a medicine arises where a medicine, which is authorised for use for a particular condition, is used for the treatment of a different condition.

He also said that the Irish Medicines Board operates a notification scheme whereby wholesalers and manufacturers are obliged to notify it of requests to import authorised medicines. “This notification scheme provides information on the use of unlicensed medicines. However, very little information is available on the off label use of medicines as a medical practitioner is not required to notify such usage to the IMB or HSE”.

Early Access to Medicines SchemeThe Fianna Fáil Health Spokesperson, Deputy Kelleher asked the Minister for Health the length of time he would monitor the progress of the Early Access to Medicines Scheme that was recently introduced in the UK before examining the possibility of introducing a similar scheme here and if he would consider bringing the pharmaceutical industry together to have preliminary talks in relation to their possible participation.

The Minister of State White said that on 14 March last the UK Government had announced the introduction of an Early Access to Medicines Scheme (EAMS) “which aims to give patients with life threatening, or seriously debilitating conditions, access to medicines that have not yet obtained a marketing authorisation from the Medicines and Healthcare Products Regulatory Agency (MHRA). I understand that, under the EAMS, medicines will be provided to patients at no charge by the relevant pharmaceutical company until they are licensed by the MHRA.

“I also understand that the UK Government does not intend to establish a dedicated fund to support access to medicines under the Scheme. There is currently no equivalent scheme in place in Ireland. I will continue to closely monitor the implementation of the EAMS in the UK. At this stage, it is premature to consider the possibility of introducing a similar scheme in Ireland”.

Why Hospital Prescriptions are transcribed into GP PrescriptionsThe Medical Council’s Guide to Professional Conduct and

POLITICS Stephen O’Byrnes

Alex White, Labour

Billy Kelleher, Fianna Fáil


Mary Mitchell O’Connor, Fine Gael

Dan Neville, Fine Gael

Ethics states that “it is in the best interests of the patient that a general practitioner supervises and guides the overall management of their health”. Consequently, medical card holders who are given a prescription by a hospital or clinic must request their GP to transcribe the details onto a GMS prescription form in order for them to receive their medication free of charge, subject to any applicable prescription charges.

This was stated by Minister of State White who was asked by Deputy Aodhán Ó Ríordáin (Labour, Dublin North-Central) why, after a medical card holder is given a prescription in a hospital, they then have to ask their doctor to get the prescription put on their medical card before they can go to a chemist for their prescription.

The Minister of State said there was an arrangement under the GMS Scheme for the emergency supply of medicines for medical card holders on discharge from hospital. “Community pharmacists are authorised to dispense a maximum of seven days’ supply of medicines prescribed for persons who have been in-patients in a hospital, or who have attended an Emergency Department and, because of the circumstances of their discharge and/or the urgency of the prescribed medication, it would not be possible to attend their GP to have the hospital prescription transcribed to a GMS prescription form. This arrangement relieves any difficulties that patients might encounter due to being discharged from hospital late in the evening or at weekends.

“I wish to assure the Deputy that it is best clinical practice that a person in need of treatment should regularly attend their GP and that the GP is fully aware of the medications that any patient may be being prescribed. This is entirely consistent with the gatekeeper role played by the GP in the delivery of primary care. As GPs receive an annual capitation fee per GMS patient there are no extra costs incurred by such patients”, he added.

Drugs Payment SchemeDeputy Maureen O’Sullivan (Independent, Dublin Central) asked the Minister for Health what were the regulations regarding pharmacy conduct around processing the Drugs Payment Scheme, and “if controls are in place to ensure that a pharmacy cannot sell more than it has ordered from its suppliers”.

Minister of State White said that since the HSE was responsible for the administration of the primary care schemes, he had asked the agency to examine the specific query raised by the Deputy and to reply to her as soon as possible.

Medical InquiryThe Pharmaceutical Society of Ireland is conducting an investigation into the death of a person who died on a Dublin street because she could not have a life-saving adrenaline injection, Minister of State White told Deputy Aengus Ó Snodaigh (Sinn Féin, Dublin South-Central).

“It would not be appropriate for me to make any further comment at this time. The Department is currently examining the feasibility of facilitating the wider availability of adrenaline pens without prescription in emergency situations, by persons trained in the administration of these pens”, the Minister of State added.

Generic Drugs SubstitutionGeneric medicines must meet exactly the same standards of quality and safety and have the same effect as the originator medicine, and all generic medicines on the Irish market are required to be properly licensed and meet the requirements of the IMB.

This was stated by Minister of State White, in reply to a question from Deputy Luke ‘Ming’ Flanagan (Independent, Roscommon-South Leitrim), who asked the Minister for Health if people on medical cards “who are forced to accept generic drugs will have the same level of treatment as

those using pharmaceutical drugs”.

The Minister of State said a key objective of the Act was to enable patients to opt for lower cost interchangeable medicines. “In general terms, when a pharmacist is presented with a prescription for an interchangeable medicine, which is not the subject of a clinical exemption, the pharmacist is obliged to offer the patient the opportunity to agree to substituting the prescribed product with an interchangeable medicine which is in stock in the pharmacy and is of lower cost to the patient or the HSE, as the case may be.

“The patient may either accept the interchangeable medicine offered by the pharmacist, or opt to receive the branded interchangeable medicine where prescribed. Alternatively, the patient may opt to go to a different pharmacy to receive a less expensive interchangeable medicine.

“The Act also allows the HSE to set a reference price for groups of interchangeable medicines. Medical card holders will only face an additional charge where a reference price has been set for a group of interchangeable medicines and the medicine dispensed is priced higher than the reference price and is not the subject of a clinical exemption”, he added.

Drugs Payment Scheme CoverageMinister of State White has asked the HSE to investigate the reasons some particular drugs are not covered by the Drugs Payment Scheme because it is responsible for the administration of the scheme.

He was replying to Dáil Questions from Deputy Mary Mitchell O’Connor (Fine Gael, Dun Laoghaire), who asked why reason the drug Myleran was not covered by the scheme, and from Deputy Dan Neville (Fine Gael, Limerick) who asked that the drugs Cysteamine and Cysteamine eye drops, which had been granted a European licence to be dispensed for the inherited metabolic disorder cystinosis, be included in the scheme.

Aengus Ó Snodaigh, Sinn Féin

Aodhán Ó Ríordáin, Labour

Luke ‘Ming’ Flanagan, Independent

Maureen O’Sullivan,Independent


Eliquis® (apixaban) reduced the risk of stroke and demonstrated fewer major bleeding events versus warfarin Bristol-Myers Squibb and Pfizer Healthcare Ireland have announced results of a pre-specified subanalysis of the Phase 3 ARISTOTLE trial in relation to patient age. ARISTOTLE was designed to evaluate the efficacy and safety of Eliquis® compared to warfarin for reducing the risk of stroke or systemic embolism in patients with nonvalvular atrial fibrillation (NVAF). The subanalysis found consistent results across age groups for reducing the risk of stroke and systemic embolism and reducing the risk of all-cause death with fewer bleeding events. Owing to the higher risk at older age (75 years and older), the absolute benefit to patients with NVAF was greater with Eliquis® in the older population. These data were recently published in the European Heart Journal.

Eliquis® was more effective than warfarin in reducing the risk of stroke and reducing mortality across age groups. In addition, Eliquis® was associated with less major bleeding, less total bleeding and less intracranial hemorrhage, regardless of age. The p-value for interaction across age groups was non-significant (p>0.11 for all) for the major outcomes of stroke and systemic embolism, major bleeding and death, meaning that the results of this subanalysis were consistent with the overall results of the ARISTOTLE trial.

Although the ARISTOTLE trial was neither designed nor powered to investigate the differences for safety and efficacy of Eliquis® compared to warfarin for individual age groups, a pre-specified subanalysis of the ARISTOTLE trial was performed according to age. The efficacy and safety of Eliquis® compared with warfarin were assessed according to age during the 1.8 years median follow-up. Of the trial population, 30% were under age 65 years, 39% were 65 to 74 years old and 31% were 75 years or older. In the overall ARISTOTLE trial population, the rates of stroke, major bleeding and death were higher in the older age groups (p<0.001 for all) across treatment groups.

High mortality and complications of invasive meningococcal disease underline need for meningococcal B vaccine to help eliminate remaining disease While introduction of the meningococcal C vaccine (MCV) in Ireland 14 years ago has almost eliminated meningococcal C disease, the country still has the highest rate of invasive meningococcal disease (IMD) in Europe, at two cases per 100,000 of population.

New research presented at the annual meeting of the European Society for Paediatric Infectious Diseases in Dublin (6-10 May) showed that, despite ongoing efforts to improve treatment and care, most children who die are already critically ill before receiving any medical attention, underlining the need for a meningococcal B vaccination strategy to help eliminate remaining disease. The research was conducted by Professor Karina Butler, Consultant Paediatrician at Our Lady’s Children’s Hospital, Dublin and University College, Dublin, Dr Cilian Ó Maoldomhnaigh and colleagues in Our Lady’s Children Hospital, and the Children’s University Hospital, Dublin.

The team analysed 382 confirmed cases of IMD from Dublin’s two children’s hospitals from 2001-2011. Following the success of MCV, almost all cases in this period (94%) were group B, 3% were group C and 3% other strains. A pre-vaccine study of 407 IMD cases from 1995-2000 provided comparative data.

The researchers found that, despite progress in care, ICU admissions remained similar both pre-and post MCV introduction (62 vs 61%). During the study period, 15 patients died, and four were dead on arrival or died in the emergency department. Median time to death was only five hours for 11 children admitted to ICU. Mortality of around 4% was similar in both groups.

Dr Ó Maoldomhnaigh concludes: “Despite MCV success and sepsis guidelines, incidence reduction has not coincided with improved outcome for those children with IMD. This data may assist Ireland’s National Immunisation Advisory Committee as it moves towards making a recommendation on use of the meningococcal B vaccine.”

Gardasil® approved in the European Union for a 2-dose schedule in children aged from 9 to 13 yearsSanofi Pasteur MSD has announced that the European Commission has granted marketing authorisation for its quadrivalent Human Papillomavirus (HPV) vaccine, Gardasil®, for a 2-dose schedule at 0 and 6 months in children aged from 9 to 13 years.

The approval of this new schedule for Gardasil® follows the positive opinion from the European Medicines Agency (EMA) granted in February, based on a Canadian study performed by Dobson et al. It demonstrates that the 2-dose 0, 6 month schedule in 9-13 year old girls elicited an immune response comparable/non-inferior to that of 3 doses in the 16-26 year old women, the population where quadrivalent vaccine efficacy has been shown. These results were sustained at 36 months of follow-up.

Adolescents aged 14 years and above should still receive 3 doses at 0, 2 and 6 months. For children aged 9 to 13 years, the 3-dose schedule can alternatively be given, in accordance with national recommendations and immunisation programmes currently in use.

Gardasil® is the only quadrivalent HPV vaccine indicated in adolescent girls and boys to help protect against cervical cancer, vulvar and vaginal precancers as well as genital warts.

Data recently published from a study in Australia showed the rapid impact of Gardasil® on disease in the real-world setting, with a strong reduction in high grade pre-cancerous cervical lesions in young women at population level. Australian national vaccination programmes with Gardasil® also resulted in the near disappearance of genital warts in Melbourne area in women under 21 years of age.

To date, more than 29 million doses of Gardasil® have been distributed in Western Europe.Gardasil® is indicated in girls and boys from nine years of age for the prevention of premalignant genital lesions (cervical, vulvar

and vaginal) and cervical cancer causally related to certain oncogenic Human Papillomavirus (HPV) types as well as genital warts (condyloma acuminata) causally related to specific HPV types.

No adverse events were presented as part of these exploratory analyses and were consistent with those previously reported for MK-3475.

STUDIES


STUDIES

Joint UK-Italian study shows association between low vitamin D status and tuberculosis in children New research presented at the annual meeting of the European Society of Paediatric Infectious Diseases (ESPID) in Dublin (6-10 May) shows an association between low vitamin D status and tuberculosis in children.

Tuberculosis is a re-emerging disease in industrialised countries and, indeed, several countries in Europe are seeing resurgence in cases and/or concentrations of cases in major cities, such as Birmingham and London in the UK, Florence in Italy, Barcelona in Spain, and Brussels in Belgium.

Recently, a role for vitamin D in the immune response to tuberculosis infection has been speculated, in both laboratory and clinical studies. Several studies have linked vitamin D status with tuberculosis in adults but only three small studies have been done so far in children. This new study is the first study in children with a matched control group, in order to strengthen the validity of the findings. They evaluated vitamin D levels in children with latent and active tuberculosis compared to healthy controls of the same age and ethnical background.

The study includes three paediatric hospitals, two in the UK and one in Italy. Vitamin D was considered deficient if the serum level was less than 25 nmol/L, insufficient between 25 and 50 nmol/L and sufficient for a level more than 50 nmol/L. The study population included 996 children screened for tuberculosis, all of whom had their vitamin D levels measured. Fifteen children (1.5%) were from Great Ormond Street Hospital, London, UK; 63 (6.4%) from Evelina London Children’s Hospital, London, UK; and 918 (92.1%) from Anna Meyer Children’s University Hospital, Florence, Italy. The median age was 5.8 years.

Of those, 44 children (4%) had active tuberculosis, 138 (14%) latent tuberculosis and 814 (82%) were controls. They showed that almost half (47%) of the children studied had either insufficient or deficient vitamin D status (less than 50 nmol/L), a proportion which increased to 58% in the latent tuberculosis and to 75% in the active tuberculosis groups. Further analysis of the data showed that children with latent tuberculosis were 61% more likely to have vitamin D deficiency compared to controls, and those with active tuberculosis were 4.6 times more likely to have vitamin D deficiency compared with controls.

About two-thirds of the children studies were of African, Asian or Hispanic ethnicity, all known to be at high risk for vitamin D deficiency. It is well known that the major risk factors in these populations are dark skin, reduced exposure to sunlight due to long clothing and a vitamin D poor diet. Similar proportions of children with these ethnicities were in each of the three hospital study groups. Interestingly, in this study, vitamin D deficiency occurred also in the Caucasian group, accounting for about one-third of the cases. Vitamin D was deficient in 33% of Caucasian children and insufficient in 37%, and normal in 30%.

The data also showed that 80% of children tested in the UK had low vitamin D status (44% deficient and a further 36% insufficient) compared to 44% of children tested in Italy (14% deficient and 30% insufficient). This difference could be mainly explained by lower sun exposure in UK with respect to Italy and probably also by the different diet within the two countries. Italy’s more Mediterranean diet is richer in vitamin D. However, the fact that almost half the children in Italy had low vitamin D status, despite good sun exposure, should increase the awareness of this problem also in countries known to be at low risk for vitamin D deficiency.

The researchers also noted that only one third of the children with low vitamin D status received vitamin D supplements.

STOCKTAKING SERVICESPHARMACY SPECIALISTS | SAME DAY AUDITABLE REPORTS

LIVE STOCK INTEGRATION WITH:

44 Church Street, Tullamore, Co. Offaly Phone/Fax 057 93 20045

Alan Daly – Director 087 2666431 Darren Donoghue – Manager 086 3809082

BCAC

M

Y

CM

MY

CY

CMY

K

ABC Advert November 12 v1.pdf 25/10/2012 12:05:42

Our new look Link guide is now available.

To join contact your Uniphar Representative.Details available on www.unipharcontact.ieOpen to ALL Community Pharmacies.

Not a memberof Link?

LINK-banner-ad.qxp_Layout 1 16/05/2014 16:57 Page 1


The Exhibition Hall at the IPU National Pharmacy Conference

CONFERENCE 2014

01

04

07

02

05

08

03

06

09


10

13

16

11

14

17

12

15

18

Opposite page: 01 Michelle O’Loughlan and Miriam Adamson from Leo Pharma. 02 Jordi Minguillon and Brian Anderson from Keito Europe. 03 Larry Landy from Lundbeck Ireland with Jennifer Browne MPSI, Haven Greene’s Pharmacy Rathfarnham, and Eilis Brennan from Lundbeck Ireland. 04 Sharon Barry, Denis Breen and Linda Murphy from ProfitPal. 05 Aisling Daly, Tonic Consultancy; Padraig Loughrey MPSI from Loughrey’s Pharmacy Longford; Conor Walker and Yvonne Sheehy from Tonic Consultancy. 06 Louise Mooney and Damien McCormack, Actavis. 07 Joey McNamara, Wendy Abbey, Sean Walsh, Noilin O’Hora and Liz Matthews from Uniphar Group. 08 Colette Donnelly Smith and Peter Cassidy from Abbvie. 09 Paul Muldoon from Daiichi-Sankyo and Sean Reilly MPSI, Reilly’s Pharmacy, Clondalkin, Dublin.

This page: 10 Katie Spillane, Siobhan Connolly, Niamh Dempsey and Niamh Kerr, all from GSK. 11 Ronan Sheridan MPSI, Market Point Pharmacy, Mullingar, and Jason Clarke, Virginia Medical Suppliers. 12 Bernadette Burke MPSI, Daly’s Pharmacy, Gort, Co Galway; Hilda Whooley MPSI, Glen Heights Pharmacy, Ballyvolane, Cork, and Caitriona Doherty, MSD. 13 Richard Collins, Claire Brennan and Alan Devine, all from Pharmawealth. 14 Shaunagh Farrelly and Emma Corcoran, from HSE Crisis Pregnancy Programme. 15 John and Gerard Cassidy from Touchstore. 16 Hammad Ahmed from Univadis (a service from MSD) with Ciara Browne and Roisin Molloy from the IPU. 17 Mark Smyth from Helix Health with Tom McKenna MPSI and Ciara Browne and Roisin Molloy from the IPU. 18 Amanda Breen from Astra Zeneca.


CONFERENCE 2014

19

22 23

24

20

25

21

26

Opposite page: 19 Bronagh White from University of Ulster and Claire Glynn MPSI, Johnson Express Pharmacy, Longford. 20 Paul Gaynor MPSI, Lusk Pharmacy; Joe Pototzzki, CubIT, and Nicola Cantwell MPSI, IT Carlow. 21 Phil Osborne and Sinead Finnucane, both from Teva; Miriam Meagher MPSI, Meaghers Pharmacy, Drogheda, and Denis Meagher. 22 Darren Donoghue from ABC Stocktaking; Yvonne Connell MPSI, Brennan Life Pharmacy, Donabate; Juliette O’Connell, Trinity College Intern, and Alan Daly from ABC Stocktaking. 23 Padraig Cronin and Rose McGrath both from United Drug; Michael Tierney MPSI, Tierney’s Pharmacy, Rathdrum, Co Wicklow, and Nichola Hosie from United Drug. 24 Paul Daly from Fannin Pharmaceutical; John Corr MPSI, Corrs Pharmacy Group, and Michael Tierney MPSI, Tierney’s Pharmacy, Rathdrum, Co Wicklow. 25 Mark Sajda MPSI, Sam McCauley Pharmacies; Barry Brennan MPSI, Brennan’s Pharmacy, Tramore, Co Waterford, with Stuart Fitzgerald and Billy Brett from Fitzgerald Power. 26 Rebecca Barry MPSI, Lloyds Pharmacy, Limerick; Peter McGill and Avril Mullett, both from Galderma, and Carmel Collins MPSI, Adare Pharmacy, Co Limerick.


29

27

32

28

33

30 31

This page: 27 Colm and Kieran Moore from Moore Wealth Management with Neil McCloy MPSI and Feargal McDermott MPSI, both from Brennan’s Pharmacy, Co Donegal. 28 Niall Tully MPSI, Tully’s Pharmacy Castlerea; Paul Fahey MPSI, Pharmapod; Leonora O’Brien, Pharmapod; Tom McKenna MPSI and Lynn O’Donnell, Pharmapod. 29 Grainne O’Leary MPSI, Gallery Quay Pharmacy, Dublin; Kevin Dolan, Clonmel Healthcare, and Michelle Concannon MPSI, Concannon’s Pharmacy, Athlone. 30 Michelle Owens MPSI, Bradley’s Pharmacy, Mulhuddart, Dublin; Creena Mulchrone MPSI, Locum Pharmacist and Brian Wood from Meda. 31 Michael Nugent and Sean Dervan, both from Energia, and Audrey Flatley MPSI, Flatley’s Pharmacy, Stranorlar, Co Donegal. 32 Darragh O’Loughlin, Secretary General, IPU; Brian Whelan MPSI, Fermoy Medical Hall, Cork; Tadhg O’Leary MPSI, O’Shea’s Pharmacy, Blackpool, Cork, and Brendan Dunne, Pfizer Healthcare. 33 Shane Finlay and Robert Heap, both from Liberty Asset Management, with Marina Gorey MPSI, Riverstown Pharmacy, Sligo, and Miriam Collis MPSI, Aranmore Pharmacy, Galway.


International pharmacy newsUK

Research funds available to improve community services

Pharmacists in the UK can apply for two new pots of funding for research into how community pharmacy can improve public health and promote wellbeing, provided by the National Institute for Health Research (NIHR).

As part of the NHS-sponsored ‘Community pharmacy; harnessing the potential for health and health care’, each fund aims to support research within one of two overall objectives; the first is to evaluate the impact of interventions delivered through community pharmacy on public health and the other aims to address knowledge gaps in community pharmacy and identify ways to improve health and wellbeing in the community.

The notice for applications highlights the opportunities for community pharmacies to make a contribution to people’s health and wellbeing as falling into three broad areas:

1. Interventions to promote health/prevent illness (e.g. support to stop smoking, address harmful alcohol consumption and to manage or reduce weight; as well as give opportunistic support for mental health and sexual health).

2. Interventions to manage or treat acute or long term illness (e.g. treatment or management of minor

illness such as colds and flu; support for self-management of long-term conditions).

3. Promoting access to both for particular population groups and for particular conditions where there is unmet need (people with learning disability, homeless people, others who tend not to access primary care).

The NIHR has not put a figure on the funding available. A spokesman said that the Institute prefers not to give guidelines on the amount of money available because it wants applicants to make accurate estimates of how much their project will cost. He added that most successful applicants for NIHR funding come from academia, or are experienced researchers.

“We are delighted,” says Beth Allen, Head of Research at the Royal Pharmaceutical Society (RPS), who has been campaigning for research funds for community pharmacists to develop and improve services.

“Successful applications will also present greater opportunities for pharmacies to participate in projects which will benefit their patients and provide development opportunities for the team.”

Source: www.pjonline.com

EU

EU Professional CardOn 7 April 2014, the European Commission published a consultation on introducing

the European Professional Card (EPC) for nurses, doctors, pharmacists, physiotherapists, engineers, mountain guides and real estate agents.

The objective of this consultation is to seek further views and collect data on issues including the mobility of professionals, application procedures and fees in the different EU countries from the professional associations and the authorities responsible for recognition of professional qualifications. The Commission will use the responses to assess whether the EPC is appropriate for the professions concerned, and what impact it will have on EU countries.

Source: PGEU Activities Report April 2014

France

Moving ahead with biosimilar substitution

New legislation in France would allow retail pharmacists there to become the first in Europe to be able to supply patients with biosimilar versions of the biologic drug indicated on the prescription.

The new rule would permit substitution under certain conditions. For example, it could only be made for a patient who is beginning a course of treatment – substitution could not be made part-way through a course. Also, it could only be done if the prescriber has not written “non-substitutable” on the form, and the product would have to be included in “similar biologic” groups; these

are still to be drawn up by the national healthcare authority, ANSM, with recommendations expected in June.

Moreover, while the new rules took effect on 1 January, they cannot go into operation until the relevant decrees have been adopted by France’s Administrative Supreme Court under the terms of the 2014 Social Security Financing Law and they would apply only to retail pharmacy, not to hospitals, where more than 40% of French prescriptions for biologic drugs are currently filled.

Source: PGEU Activities Report April 2014

Scotland

Registration for Minor Ailments Scheme in Scotland approaches one millionNearly a million people in Scotland are currently registered with community pharmacies for the minor ailment service. According to the latest figures, reported in response to a written Scottish Parliamentary Question, 956,858 people are registered for the minor ailment service and 385,210 people are registered for the chronic medication service.

Source: www.pjonline.com

INTERNATIONAL NEWS Roisin Molloy, Membership & Secretary General’s Office Manager, IPU


NEWS

BowelScreen – The National Bowel Screening Programme is now available to men and women aged 60-69BowelScreen – The National Bowel Screening Programme, a Government-funded programme, is now offering regular free bowel screening to men and women aged 60 to 69. Bowel screening involves a free, quick, easy-to-use BowelScreen home test every two years, while in the age-range. Information is available at www.bowelscreen.ie.

The BowelScreen home test looks for tiny amounts of blood in the bowel motion (also called a stool) which are not visible to the eye. Most people will have a normal result (95%). In the small number of cases where a result shows traces of blood not visible to the eye, a colonoscopy will be offered

in a screening colonoscopy unit in a hospital organised by BowelScreen.

BowelScreen is a quality-assured bowel cancer screening programme, based on international evidence that will, over time, offer free bowel screening to over one million people aged 55 to 74.

Information about the programme is available at: www.bowelscreen.ie or from Freephone 1800 45 45 55. A public information campaign is beginning, which will support the programme in addition to information leaflets, information line and website.

New smartphone app depicts life through eyesA new smartphone app – AMD Aware – has been launched by NCBI – the national sight loss agency, and supported by Bayer, which aims to bring home the stark reality of life for a person with the eye condition AMD (Age-related Macular Degeneration). There are approximately 22,000 people in Ireland living with sight loss as a result of AMD, with numbers expected to rise by more than 45% by the year 2020.

With AMD Aware, users can, at the touch of a button view for themselves what the world is like as seen through the eyes of someone with AMD, which, at its most serious, results in a blank patch appearing in the centre of a person’s vision. Pictures can be taken by the user, which show what it’s like to have different stages of the disease and these can also be shared with friends and family to generate greater awareness on what it means to live with the condition. The app is available free of charge for download from the Apple app store by simply searching for ‘AMD Aware’.

Apart from simulating the condition, the app provides user-friendly information on what AMD is; its causes, symptoms, diagnosis and treatment. Details of NCBI services are also available as well as information on looking after our eyes.

People with eye health concerns are encouraged to visit their optometrist or ophthalmologist, while people having difficulties managing as a result of reduced vision should contact the NCBI – call 01 830 7033 or visit www.ncbi.ie.

Pictured at the launch of the new smartphone app were L-R: Lynda McGivney Nolan, Optometrist and Optometric Advisor, Association of Optometrists Ireland, Mr David Keegan, Consultant Ophthalmologist, Mater Misericordiae University Hospital, Anne Doyle, former RTÉ newscaster, Des Kenny, CEO, NCBI Group, Katie Carroll, Business Unit Manager, Bayer Ltd and Chris White, CEO Designate, NCBI Group.


HIQA publishes guidance aimed at reducing medication errorsThe Health Information and Quality Authority (HIQA) has published Principles of Good Practice in Medication Reconciliation to offer guidance to healthcare professionals aimed at reducing medication errors.

Medication errors make up a significant number of patient safety events across the world and can potentially lead to very serious outcomes as patients move between different health and social care settings.

Medication reconciliation is the process of creating and maintaining the most accurate list possible of all medications a person is taking in order to identify any discrepancies and to ensure any changes are documented and communicated. This results in a complete list of medications which can then be communicated to the next care provider.

Checklists are recognised as a useful tool to ensure that all the steps in the process are followed and this guidance includes four examples which have been developed and tested in hospitals and nursing homes in Ireland. The guidance is available to download from www.hiqa.ie.

Guidance for health and social care providers

Principles of good practice in medication reconciliation

May 2014


PRODUCT INFORMATION

Roche discontinue Fuzeon 90 mg/ml powder and solvent Roche Products (Ireland) Limited (“Roche”) has announced the discontinuation of Fuzeon 90 mg/ml powder and solvent for solution for injection (EU/1/03/252/001) effective from 31 July 2014. Stock remaining in circulation should be employed until exhausted (expected to occur in July 2014).

Clavamel (Co-Amoxiclav) out of stockClonmel Healthcare has advised that Clavamel (Co-Amoxiclav) 250 mg/125 mg Film-coated tablets (PA 126/103/1) will be out of stock for the foreseeable future. Clonmel Healthcare regrets any inconvenience caused and will advise when it is back in stock.

Change in distribution of Testogel® (testosterone 50mg) Bayer Healthcare has announced a change in the distribution of Testogel® in the Irish market. Until now, the product had been distributed by Bayer Ltd under an agreement with the product marketing authorisation holder, Besins.

Commencing 1 June, distribution of Testogel will move to the newly established Besins Healthcare in Ireland. Besins has appointed United Drug, Dublin as their Irish distributor, and orders for Testogel after 1 June can be placed directly with them.

In case of questions Besins Healthcare can be contacted on +44 1672 516885 or email [email protected]. Alternatively, contact Bayer Healthcare on 01 2999 313 for further details.

Tasectan educational campaignOcean Healthcare recently ran an education programme targeting OTC staff and pharmacists on the benefits of Tasectan® in treating diarrhoea for the whole family. Over 1500 entries were received and the winners won the latest Apple iPad. Pictured is prize winner Lindsay Dunne, Kelly’s Pharmacy, Nenagh, Co Tipperary with Anne Louise French, Territory Manager, Ocean Healthcare

Ocean Healthcare would like to thank all the pharmacies and their staff who entered the competition. For further information on Tasectan please visit www.diarrohea.ie or contact Ocean Healthcare at 01 296 8080.

Kora Healthcare extends its Vitamin D portfolioKora Healthcare announce the launch of its latest addition to its Vitamin D portfolio – Kora LiquiD®. Kora LiquiD® is an oral cholecalciferol solution, containing 3,000 IU per mL, equivalent to 15,000 IU per 5 mL in a 100mL bottle.

Both Vitamin D deficiency and insufficiency remain a public health issue and are widely discussed in both professional literature and increasingly in the public media. Kora LiquiD® enables personalised dosage with its oral dosing syringe and provides patients with convenience and value through its availability and longer shelf life than “specials” which it replaces.

Following the launch of Kora LiquiD®, Margaret Larkin, Kora Healthcare’s CEO commented that “Kora listens closely to our customers and today KoraLiquiD® provides them with higher strength liquid vitamin D, manufactured to high quality standards whilst being readily available from United Drug wholesale’’.

For further information about KoraLiquiD®, please contact 01 890406.


NOMAD CLEAR (CL01)Pack of 250

€120 plus VAT

Contact: O’Mahony and Ennis at 01 2801163 Agents for the complete NOMAD range

CHECK

OUT OUR

LOW

PRIC

ES!Nomad Blister Packs

For the community and care home setting

Safe and Easy To Use!

Only

48c plus

VAT per

patient

With the advent of Reference Pricing, make the savings now!

Contact Eileen BrowneE: [email protected] T: 087 6869132

www.barrypackaging.com

See you at the United Drug Pharmacy Showin the Aviva Stadium, Dublin 8th, 9th and 10th June.


CLASSIFIEDS

MUNSTER AND LEINSTER REGIONS. Pharmacies with turnover in excess of €1.5m required. Serious sellers only. Confidentiality assured. Replies to Box No 1014.

PHARMACIST WISHING TO PURCHASE A PHARMACY IN THE GALWAY/MAYO REGION. All areas and turnovers considered. All enquiries treated with the strictest of confidence. Replies to Box No 1114.

PHARMACY FOR SALE IN LIMERICK SUBURB. Established pharmacy with good turnover in prominent location in Limerick Suburban location for sale. Replies to Box No 1214.

PHARMACIST SEEKING TO PURCHASE PHARMACY IN GALWAY / CLARE AREA. All turnovers considered. Funding in place, confidentiality assured. Replies to Box No 1314.

LOOKING TO SELL YOUR PHARMACY? Pharmacist with funds wishes to purchase pharmacy in Leinster area. Replies to Box No 914.

ENTHUSIASTIC PHARMACIST SEEKING TO PURCHASE a pharmacy in Leinster region, preferred locations anywhere in Co Kildare, North East/East Offaly. Confidentiality is guaranteed. Replies to Box No 814.

YOUNG PHARMACIST IN THE WEST OF IRELAND wishes to purchase pharmacy. Has his own deposit and approval in principle from the bank. Would prefer €1m turnovers and over. However, all turnovers and areas of country considered. Replies to Box No 614.

All Box Number Replies should be to: Irish Pharmacy Union, Butterfield House, Butterfield Avenue, Rathfarnham, Dublin 14.

This independent service is free to IPU members. Entries will be deleted after three months.

Advertisements should be forwarded to: Wendy McGlashan, IPU, Butterfield House, Butterfield Avenue, Rathfarnham, Dublin 14. Tel: (01) 493 6401. Fax: (01) 493 6626. Email: [email protected]

IRISH/UK PHARMACY CHAIN SEEKING

TO ACQUIRE PHARMACIES WITHIN

DUBLIN AREA Available Funding.

All options considered and strict confidentiality is guaranteed.

Replies to PO Box SA026.

LEINSTER REGION - PHARMACY WANTEDApproved funding to purchase pharmacy for enthusiastic young pharmacist. All options

considered and confidentiality is guaranteed. Replies to Box No SA030.

SUPERVISING PHARMACIST POSITION AVAILABLE

in independent community pharmacy in Co. Tipperary. 4 days per week.

Please email CV to [email protected]

SUPPORT PHARMACIST REQUIRED on a 3 day week for independent community

pharmacy in Co. Tipperary. Please email CV to [email protected].

TO ADVERTISE HERE, PLEASE CALL WENDY ON 01 493 6401

STOCKTAKING SERVICESPHARMACY SPECIALISTS | SAME DAY AUDITABLE REPORTS

LIVE STOCK INTEGRATION WITH:

44 Church Street, Tullamore, Co. Offaly Phone/Fax 057 93 20045

Alan Daly – Director 087 2666431 Darren Donoghue – Manager 086 3809082

BCAC

M

Y

CM

MY

CY

CMY

K

ABC Advert November 12 v1.pdf 25/10/2012 12:05:42


THE POWER OFPANADOL WITHSINUS RELIEF

Abbreviated Prescribing Information. Please consult the summary of product characteristics for full prescribing information. Product Information for Panadol Sinus Relief film coated tablets (Paracetamol 500mg, Caffeine 25mg, Phenylephrine Hydrochloride 5mg). Therapeutic indications The product is recommended for the relief of the symptoms of nasal and sinus congestion, colds and flus. Posology and method of administration For oral administration only. Adults (including the elderly) and children aged 12 years and over: 1 to 2 tablets up to 4 times a day. Not recommended for children under 12 years of age. Do not exceed the stated dose. Maximum daily dose: 8 tablets in 24 hours. Minimum dosing interval: 4 hours. Maximum duration of continued use without medical advice: 3 days. Should not be used with other paracetamol-containing products, decongestants, or cold and flu medicines. Contraindications Known hypersensitivity to paracetamol, phenylephrine, caffeine or any of the other ingredients. Use in children under 12 years of age. Severe hepatic or severe renal impairment, hypertension, hyperthyroidism, diabetes, closed angle glaucoma, phaeochomocytoma, prostate hypertrophy and heart disease. Patients taking tricyclic antidepressants, or beta-blocking drugs and those who are taking or who have taken within the last two weeks monoamine oxidase inhibitors. Special warnings or precautions for use Patients who have been diagnosed with liver or kidney impairment must seek medical advice before taking this medication. Underlying liver disease increases the risk of paracetamol related liver damage. Excessive intake of caffeine (e.g. coffee, tea and some canned drinks) should be avoided while taking this product. Prolonged use except under medical supervision may be harmful. Do not exceed the stated dose. Take only when necessary. If symptoms persist, consult your doctor. Patients should be advised not to take other paracetamol-containing products concurrently. Medical advice

should be sought before using this product in patients with occlusive vascular disease (e.g. Raynaud’s phenomenon). This product should not be used by patients taking other sympathomimetics (such as decongestants, appetite suppressants and amphetamine-like psychostimulants). Keep out of the reach and sight of children. Consult your doctor if you are taking warfarin or have been diagnosed with liver or kidney disease. Interactions with other medical products and other forms of interactions Medical advice should be sought before taking paracetamol-caffeine-phenylephrine in combination with the following drugs: Monoamine oxidase inhibitors, Sympathomimetic amines, Beta-blockers, and other antihypertensives (including debrisoquine, guanethidine, reserpine, methyldopa), Tricyclic antidepressants (e.g, amitriptyline), Digoxin and cardiac glycosides, Warfarin and other coumarins. The absorption of paracetamol may be increased by metoclopramide and domperidone and reduced by cholestyramine, however, these interactions are not considered to be clinically significant in over-the-counter paracetamol-containing products which are intended for short term usage. Enzyme-inducing drugs may increase hepatic damage, as does excessive intake of alcohol. Pregnancy This product is not recommended for use during pregnancy. Lactation This product should not be used while breast-feeding without medical advice. Side effects of paracetamol: All very rare: Thrombocytopaenia, anaphylaxis, cutaneous hypersensitivity reactions including skin rashes, angiodema, and Stevens Johnson syndrome, bronchospasm in patients sensitive to aspirin and other NSAIDs, hepatic dysfunction. Side effects of caffeine: Nervousness, dizziness. When the recommended paracetamol-caffeine dosing regimen is combined with dietary caffeine intake, the resulting higher dose of caffeine may increase the potential for caffeine-related adverse effects such as insomnia, restlessness, anxiety, irritability, headaches, gastrointestinal disturbances and

palpitations. Side effects of phenylephrine: Nervousness, headache, dizziness, insomnia, increased blood pressure, nausea, vomiting. Overdose Paracetamol Immediate medical attention (in-hospital, if possible) is required in the event of overdose, even if there are no significant early symptoms. Caffeine Overdose of caffeine may result in epigastric pain, vomiting, diuresis, tachycardia or cardiac arrhythmia, CNS stimulation insomnia, restlessness, excitement, agitation, jitteriness, tremors and convulsions). It must be noted that for clinically significant symptoms of caffeine overdose to occur with this product, the amount ingested would be associated with serious paracetamol-related liver toxicity. Phenylephrine overdosage is likely to result in effects similar to those listed under adverse reactions. Additional symptoms may include irritability, restlessness, hypertension, and possibly reflex bradycardia. In severe cases confusion, hallucinations, seizures and arrhythmias may occur. However the amount required to produce serious phenylephrine toxicity would be greater than required to cause paracetamol-related liver toxicity. MARKETING AUTHORISATION HOLDER GlaxoSmithKline Consumer Healthcare (Ireland) Ltd, Stonemasons Way, Rathfarnham, Dublin 16 and any requests for further information should be sent to this address. Product Authorisation Number PA 678/44/1. Date of Revision of the Text July 2013. Legal Category: Pharmacy Only. CHPAN/0077/13 Date of preparation: August 2013

NEWMGS2437 IPU review.pdf 1 19/09/2013 11:40

ipu review, june 2014

Documents