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Medications in the lactose intolerant adult: Lactose is the carbohydrate naturally found in all kinds of milk, including human milk. It can also be used as an ingredient in some foods and is commonly used as a filler or excipient in pharmaceutical preparations (both tablets and capsules) including prescription, over the counter and complementary medicines. Lactose can also be used in dry-powder inhalations and rarely in liquid preparations. Approximately one in five prescription products contain lactose.   Lactose intolerance can occur when person has insufficient lactase, resulting in the inability to break down lactose and causing maldigestion that leads to undigested lactose passing through to the colon. In the lower bowel natural bacteria ferment the lactose, producing acid and gas which may cause symptoms of lactose intolerance (including abdominal pain, bloating and diarrhoea). Deficiency of lactase varies with race and increases with ... [Readmore]
Can Calcium Supplementation Cause Heart Attacks? One of the most common topics that I come across in home medication reviews with elderly patients is calcium supplementation. Recent research has shown that calcium supplements are associated with an increased risk of heart attacks. As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population. The study looked at calcium supplements that did not contain vitamin D. Vitamin D deficiency has been associated with increased risk of heart disease and there have been studies showing that vitamin D supplementation is associated with decrease mortality. An important point to realise is that this study looked at calcium supplementation, not dietary calcium. In previous studies, women with high levels of dietary calcium intake have been found to have a decreased risk of stroke and heart ... [Readmore]
Home Medication Reviews are here to Stay As you may be aware there was a recent call for a moratorium on home medication reviews (HMR) by the pharmacy guild due to overspend on the program. I am pleased to announce that the health minister has decided against a moratorium due to the value and importance of HMRs in the community and has increased the funding for the program to continue. She has made some changes to the program to ensure its sustainability and to optimise patient outcome. Changes include; - Medication reviews to be conducted in the patient’s home by an accredited pharmacist. Under the program HMRs can only be conducted outside the home of clients where there is pre-approval for defined circumstances – such as patient or pharmacist safety, or for cultural reasons (gained through Medicare)   -To ensure the best result for consumers the ... [Readmore]
Vitamin D status has emerged as a significant public health issue in Australia. An estimated 31% of adults in Australia have inadequate vitamin D status (serum 25-hydroxyvitamin D [25-OHD] level < 50 nmol/L), increasing to more than 50% in women during winter–spring and in people residing in southern states. This article provides updated guidance to clinicians and health professionals on the role of vitamin D in health for adults. The prevalence of vitamin D deficiency varies, with the groups at greatest risk including housebound, community-dwelling older and/or disabled people, those in residential care, dark-skinned people (particularly those modestly dressed), and other people who regularly avoid sun exposure or work indoors. Most adults are unlikely to obtain more than 5%–10% of their vitamin D requirement from dietary sources. The main source of vitamin D for people residing in Australia and New Zealand is ... [Readmore]
White L, Klinner C. Source Charles Sturt University, Faculty of Business, Panorama Avenue, Bathurst, NSW 2795, Australia. Abstract There is a paucity of research into the perceptions of elderly Australian ethnic minorities towards public health services related to quality use of medicines. Among the six fastest growing ethnic groups in Australia, the Mandarin-speaking Chinese and Vietnamese constitute the largest elderly populations with poor English skills. This paper investigates the relationships of elderly Chinese and Vietnamese migrants with medicines, general practitioners and pharmacists, and how these relationships influence their awareness and attitudes of the home medicines review (HMR) program. Two semi-structured focus groups were held with a total of 17 HMR-eligible patients who have never received a HMR, one with Chinese and one with Vietnamese respondents, each in the respective community language. Confusion about medications and an intention to have a HMR were pronounced among ... [Readmore]
Medication reviews in the community: results of a randomized, controlled effectiveness trial Abstract To examine the effectiveness of a multidisciplinary service model delivering medication review to patients at risk of medication misadventure in the community.Methods The study was carried out in three Australian states; Queensland, New South Wales and Western Australia, and conducted as a randomized, controlled effectiveness trial with the general practitioner (GP) as the unit of randomization. In total, 92 GPs, 53 pharmacists and 400 patients enrolled in the study. The multidisciplinary service model consisted of GP education, patient home visits, pharmacist medication reviews, primary healthcare team conferences, GP implementation of action plans in consultation with patients, and follow-up surgery visits for monitoring. Effectiveness was assessed using the four clinical value compass domains of (i) functional status, (ii) clinical outcomes, (iii) satisfaction and (iv) costs. The domains of functional status (assessed ... [Readmore]
From Melissa Sweet's post in Crikey: ...."It is axiomatic that two professionals from complementary but distinct disciplines will provide better care than one professional.  The fact is that doubling the number of health professionals will be a more expensive service.  Understanding what features of collaborative care result in health gains are critical if we are to afford the better health care that we all want.”... read the article here [Readmore]
Randomized controlled trials have demonstrated that collaborative medication reviews can improve outcomes for patients with heart failure. We aimed to determine whether these results translated into Australian practice, where collaborative reviews are nationally funded. The conclusion was that Medicines review in the practice setting is effective in delaying time to next hospitalization for heart failure in those treated with heart failure medicines. Click here for the full journal article   For more information on the HMR process, please click here [Readmore]
The Home Medicines Review is continued under the Fifth Community Pharmacy Agreement  in accordance with arrangements set out under the Fourth Community Pharmacy Agreement. Changes will be made to the Home Medicines Review program as part of the Fifth Community Pharmacy Agreement. The Home Medicines Review (HMR) is funded under the Fourth Community Pharmacy Agreement designed to assist individuals living at home to maximise the benefits of their medicine regimen and prevent medication related problems. It is not available for in-patients of a hospital, day hospital facility or care recipients in residential aged care facilities. The review involves the consumer's general practitioner and preferred community pharmacy and in some cases other relevant members of the healthcare team such as nurses in community practice or carers are included. In cooperation with the individual's general practitioner, the pharmacist visits the individual at home, reviews their ... [Readmore]

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