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Australian Journal of Pharmacy : February 2005
Diabetes briefs release in mid-2004 of the Diabetes Aus- tralia Action Plan opening the door for discussions with Diabetes Australia. ‘It has broadened the options for getting a better deal not only for people with dia- betes but also for community pharmacy. The fact is, without community pharmacy the NDSS (National Diabetes Supply Scheme) would fall over tomorrow.’ Mr Emerson stated that discussions, may ultimately lead to a more satisfactory arrangement for reimbursing pharmacy and an agreement on how sub-agencies may be allocated. ‘The NDSS contract comes up for renewal in July 2006. The Government has to give Diabetes Australia one year’s notice of their intention to either renew or end the five-year contract, or put it to ten- der by July 2005. I hope that the Guild and Diabetes Australia can work together to get a better deal for people with dia- betes and also community pharmacies in administering the NDSS.’ He said recent Guild surveys show that community pharmacies on average lose about $3,500 a year on administering the NDSS, even after patient loyalty is taken into account. ‘The situation needs to change. Com- munity pharmacies cannot continue to deliver under the current scheme because it is unsustainable. This is what the Guild intends discussing with Diabetes Australia.’ The chief executive officer for Diabetes Australia, Brian Conway, told the AJP that 1,500 pharmacies nationally were involved in the NDSS. ‘Diabetes Australia is working closely with the Pharmacy Guild to improve the NDSS service and efficiency. Diabetes is growing and we look to pharmacy to help those with the disease with their medica- tion management.’ He said Diabetes Australia was devel- oping awareness programs that he hoped would involve pharmacy but discussions were in the very early stages. Also on the priority list was to continue lobbying for new, innovative and effective drugs that treated diabetes to be listed on the Pharmaceutical Benefits Scheme, such as Lantus (insulin glargine), the once-daily Diabetics suffer more psychological distress D EPRESSION and anxiety is more common in adults with diabetes than those without diabetes, according to researchers in the United States. A report in the Morbidity and Mortality Weeklysaid this group is more likely to experience these disorders that cause serious psychological distress (SPD). As well as suffering SPD along with diabetes, these people were more likely to be divorced, separated or widowed and had an annual household income of less than US$25,000 a year. Premature birth a possible risk factor for diabetes C insulin analogue with a peakless profile. ‘We are continuing to lobby the PBS to get listing for the long-acting insulin drug, glargine.’ Mr Conway said glargine was particu- larly beneficial for parents because it reduced the likelihood of hypoglycemia in younger patients, which was a great concern. However, insulin glargine has not been included in the latest PBS recommenda- tions from the Pharmaceutical Benefits Advisory Committee. Pharmacy facing pressures Sydney pharmacist, Brendan O’Lough- lin, says increasing pressures on time has made the diabetes proposition less feasi- ble for pharmacy. ‘The NDSS system has created a signif- icant amount of tension around the area of diabetes and this needs to be clarified. ‘Diabetes Australia, I believe, recog- nises that in the interest of patient care we need to work together to achieve the best health outcomes. ‘To do it well takes a lot of time and expense and pharmacy should be reim- bursed for all of that—these are the chal- lenges. But, it can be done. ‘The public need in this area is huge, so improved diagnosis and improved care is essential in order to reduce those end stage costs. Earlier diagnosis means better HILDREN born prematurely have an isolated reduction in insulin sensitivity which may be a risk factor for type 2 diabetes mellitus, according to results from a New Zealand study published in the New England Journal of Medicine. The authors wrote that: ‘The identification of an increased risk of disease well before any clinical manifestations occur leaves a large window of time in which to institute interventions that might delay or prevent overt disease.’ management of the patient and improv- ing the quality of life of the patient.’ The impact on the individual patient, not diagnosed early, results in quite exten- sive damage, Mr O’Loughlin said. And, for pharmacy considering taking up diabetes like asthma and other critical healthcare services, developing a plan is the first step. Next comes training and deciding who will be responsible for running the dia- betes area in the pharmacy. ‘Also, if that person leaves, who takes over the role and how do you retrain that person? The level of training for support staff must be decided and to what extent that must be on an on-going basis. ‘The next step is deciding on a sub-sec- tion within the pharmacy—space alloca- tion, shelf space, counselling areas, sec- tions for the machines allowing for quick and easy access.’ Mr O’Loughlin says active promotion is vital but expensive. ‘So, the pharmacy needs to budget for signage, pamphlets and newspaper advertising.’ He said any adver- tising that illustrates the tick- test to enable a risk assessment process can be used to encourage people to visit the pharmacy. Also a believer that pharmacy could extend its role in diabetes care is Profes- sor Louis Roller, associate dean of teach- ing at the Faculty of Pharmacy, Monash University. THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 FEBRUARY 2005 ? 97