Home' Australian Journal of Pharmacy : Jan Feb 2015 Contents Consumer Medicine Information
(CMI) leaflets should be provided
on initiation of any prescription
medicine and offered at each
subsequent dispensing according to
established guidelines. Discussing
the contents of a leaflet in the
context of the individual’s medical
history and circumstances should
minimise confusion or alarm.
Written information is intended
to supplement verbal counselling.26
Health literacy will, of course, need
to be considered. The use of CMIs
and documentation that they have
been given or offered should cover
possible litigation issues. A British
paper showed that when patients
were provided with a Patient
Information Leaflet (similar to a
CMI), among those who read it, the
side effects section was the most
commonly read.30 This paper also
showed that participants preferred
the use of absolute frequency
descriptors rather than verbal
descriptors for conveying side
Consumers should be encouraged
to report any perceived adverse
effect or concern with their medicine
to their pharmacist or doctor, who
can then take action if necessary. This
advice is particularly important when
initiating a new therapy, and when
medicines are new to the market.
Reporting of ADRs is not done well
but without that data it is hard to
issue warnings when new ADRs arise.
Adverse effect monitoring to the
Therapeutic Goods Administration
(TGA) is mandatory.33
Table 5 lists some suggestions
about common harmful adverse
effects that pharmacists should
consider talking about when
dispensing new medicines and also
reinforcing the need to counsel
with repeat prescriptions. This
table is not exhaustive. It is simply
a guide to illustrate some aspects
of communicating safety issues
and risk reduction. The depth and
Education DISEASE STATE MANAGEMENT
breadth of the information provided
will depend on the needs of the
consumer but the information
must be accurate and in date. Often
health professionals provide more
information than the consumer
actually wants. Safety for the use
of medicines is the criterion to
encourage adherence but be aware
of adverse effects and the action to
take if they occur.
Emphasis of data from randomised
trials, provision of numerical
estimates of absolute risk of adverse
reactions, discussion of the nocebo
phenomenon, and positive framing
of information about ADRs are
strategies worthy of consideration
in the attempt to improve outcomes
from drug treatment of chronic
diseases in individual patients.6 In
some cases prescribers could use a
screening test to check the patient’s
perceived sensitivities and the risk
of nocebo responses. A trial of
the medicine using a ‘start low go
slow’ process can help individual
patients in decisions about
Medication adherence rates in
Australia are low, averaging only
50–65% for many medicines. This
leads to poor health outcomes,
and unnecessarily increased
healthcare costs.5,35 If medicines
are not taken in accordance with
the prescriber’s directions, or the
patient discontinues treatment
early due to a lack of support or
understanding of the medicine’s
purpose or its side-effects, some or
all of the taxpayer cost of subsidising
the medicine can be wasted as
the desired health benefits are
not achieved. An IMS study in
2012 estimated that a $6 billion
avoidable cost opportunity, or 7.7%
of total health expenditure, exists
in Australia across these areas with
non-adherence contributing more
than 50% of this figure.35
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THE AUSTRALIAN JOURNAL OF PHARMACY VOL.96 JANUARY/FEBRUARY 2015 | 69
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drug reactions BMJ 2014;349: g5019.
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5. Aslani P, Schneider M. Adherence: The journey
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media and health information seeking behaviour.
PLoS One, 2012;7(4): e34314.
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health journalism is important for public health.
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effects of medicines BMJ 2014;348–9.
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information: A guide for patients and carers,
3rd edn. Melbourne: St Vincent’s Hospital &
The University of Melbourne, November 2013.
Available at: www.svhm.org.au/services/
24. Berk M, Parker G. The elephant on the
couch: Side-effects of psychotherapy. Aust NZ J
Psychiatry 2009 43:787–94. Available at http://anp.
25. Myths and realities: Responding to arguments
against immunisation. A guide for providers, 5th
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2013. Available at www.immunise.health.gov.au/
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York: Promethasus Health, 2005.
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nocebo phenomenon. JAMA 2002;287:622-7.
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formulary and handbook, 22nd edn. Canberra:
Pharmaceutical Society of Australia, 2012.
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UK Regulatory recommendations. Drug
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35. IMS Institute for Healthcare Informatics:
Responsible use of medicines report, October
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