Home' Australian Pharmacist : Australian Pharmacist February 2012 Contents Australian Pharmacist February 2012 I ©Pharmaceutical Society of Australia Ltd.
THE NATIONAL PRESIDENT SAYS
Figures released during National Medication
Safety Week late last year paint a sobering
picture of the extent of medication
misadventure in Australia, and the cost this
is having on the health system.
Approximately 200 million prescriptions are
dispensed each year on the Pharmaceutical
Benefits Scheme (PBS), at a cost of about
$8.3 billion to the health system. However, it
is estimated that in Australia, some 190,000
medicine-related hospital admissions occur
each year and the associated cost of these to
the public health system is in the vicinity of
$660 million a year.
Quite staggeringly, the figures released
during National Medication Safety Week
showed that somewhere between 23--73%
of adverse drug events are preventable.
While no figures are available as to which of
these misadventures are due to confusion
over generic medicines, clearly such
problems must be taken into account.
A report in the Medical Journal of Australia
(MJA) late last year quotes the 2003 report,
Adverse drug events and medication errors
in Australia, saying almost 25% of patients
admitted to hospital a decade ago received
inappropriately prescribed medicines.
As 40% of patients aged over 70 years
receive more than five medicines, they are
increasingly vulnerable to medicine errors.
The MJA report points to the study Generic
substitution of commonly used medications:
Australia-wide experience, 2007--2008,
also published in the MJA, which shows
increasing brand substitution due to the
proliferation of generic medicines, adds
to the potential for confusion and the
likelihood of medication misadventure.
Pharmacists have a pivotal role to play
in reducing medication misadventure,
particularly in relation to generic confusion
No need for generic
where some problems can be addressed
before they are encountered.
A major factor is encouraging patients
to return to the same pharmacy for their
medicines, the pharmacy where their
records are kept, where the same generics
are generally dispensed and where staff
know them and can better help with their
Patients should also be encouraged to
visit their pharmacist as soon as possible
after any hospitalisation that has required
a change in their medicines regimen. On
discharge they may be given medicines
of a different generic brand and often
confusion arises at this time when a patient
is very vulnerable.
Pharmacists need to make better use of
advisory labels such as the one for use on
a generic medicine which clarifies when
a change is being made for an existing
medicine to a new brand. This specific
label can be very useful to consumers,
and also helpful to pharmacists when
Pharmacists need to be ever-vigilant in
helping consumers over any confusion
they may have with generic prescription
medicines. A point to note here is that
generics are usually offered primarily as a
cost-saving opportunity for the consumer.
Because they must be pharmacologically
equivalent to their branded comparators,
the efficacy of the branded and generic
medicines is the same. However, there
will be times when suggesting a generic
may not be suitable because of a number
of QUM reasons including: their size, it
may be difficult for the patient to swallow;
there may be issues over the coating of the
tablet; a different colour and shape to other
medicines the patient is taking which can
all contribute to potential adherence and
PSA's Guidelines for Pharmacists on PBS
Brand Substitution, which will be updated
this year, point to a number of steps
pharmacists should take when dealing with
• Pharmacy staff should be trained to assist
the pharmacist in informing and educating
patients about generic medicines.
• Pharmacists should have systems in place to
ensure that all patients have the opportunity
to request a generic equivalent.
• Brand substitution may only occur after
consultation with and agreement of
the patient and if the prescriber has not
indicated on the prescription 'no brand
substitution', or equivalent.
• Where substitution is allowed and the
patient is offered or enquires about alternate
brands, the pharmacist and the patient
should discuss the safety and suitability of
alternate brands for that patient.
• The patient's health should always be the
pharmacist's prime consideration in any
brand substitution decision.
• Decisions to substitute one brand for
another should not place patients at risk of
• Pharmacists should endeavour to be
consistent in the selection of brands for
patients on long-term therapy in order to
avoid patient confusion. If this is not possible
then the patient should be consulted.
• Pharmacists should encourage (or
offer to assist) patients to have their
medicine regularly reviewed to check for
duplication of different brands of the same
• Pharmacists should discuss brand
substitution issues with their local
prescribers to maintain and improve
professional relationships and
minimise the chances of any conflict or
Medicine misadventures, including those
arising from generic medicines, have
managed to push health care into what
is regarded as a high-risk category. Some
industries, once perceived as high risk are
safer than health care -- for example, there is
a one in 1,000,000 risk of harm from air travel
while there is currently a one in 300 risk of
harm from health care.
It is incumbent upon all of us in the profession
to do everything we can to help to reduce
that disturbing statistic.
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