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Aim: To determine the validity of electronic hospital pharmacy dispensing records as an indicator of late gestation exposure to antidepressants using medical records as the gold standard. Method:Medical records (gold standard) were reviewed for a consecutive sample of 400 women who delivered at a large maternity hospital during 2005. Data on antidepressants used in pregnancy from the medical records were compared with the electronic pharmacy dispensing records to ascertain sensitivity and specificity. Results: According to the medical records, 12 (3%) women were identified as taking antidepressants during late gestation. The electronic pharmacy dispensing records correctly identified 9 women as exposed to antidepressants (sensitivity score 75%; 95%CI 43-95). No women were classified as exposed according to pharmacy dispensing records and classified as not exposed according to the medical records (specificity score 100%; 95%CI 99-100). 7 (1.8%) women were identified in the medical records as taking antidepressants but had either stopped prior to pregnancy or on finding out that they were pregnant. These patients were not identified in the pharmacy dispensing records. Conclusion: Electronic hospital pharmacy dispensing records may provide an efficient alternative to paper records for identifying late gestation exposure to antidepressants, but will underestimate the exposure by 25%. [ABSTRACT FROM AUTHOR]

Objective: To explore South Australian (SA) pharmacy interns' values, beliefs and motivations to study pharmacy and their assessment of how well their pharmacy education has prepared them for activities required of all health professionals under Australia's health care reforms., Methods: A postal questionnaire was sent to all 136 SA pharmacy interns enrolled in SA intern training programmes in February 2010 (second month of the intern training programme)., Key Findings: Sixty (44%) of SA pharmacy interns responded; 75% selected pharmacy as a career because of an interest in health-related sciences and 65% valued working with patients. Respondents believed their pharmacy education prepared them for patient care (80%), providing medicine information (72%) and primary health care delivery (68%), but 51% indicated that they were not prepared for multidisciplinary team care., Conclusions: The positive values, beliefs and motivations expressed by respondents are significant behavioural precursors to meet the requirements of health professionals in Australia's health care reforms. Respondents indicated that their pharmacy education provided appropriate training in a number of relevant professional areas., (© 2014 Royal Pharmaceutical Society.)

Objective: The aims were to determine Australian registered pharmacists' current employment status, practice profile and professional satisfaction., Method: A questionnaire was mailed to all registered pharmacists (n=7764) on the Pharmacy Boards of Victoria and South Australia's registers; 19 were returned undeliverable. Quantitative data were entered and analysed using the Statistical Package for Social Sciences Version 17. Qualitative data were subjected to a thematic analysis., Results: 1627 (21%) pharmacists responded: 259 (16%) were registered as pharmacists but no longer worked in the pharmacy profession. A total of 1366 respondents reported still working as pharmacists. Of the 1366, 912 (67%) indicated that they spend most of their time in a clinical area; 233 (17%) spend most of their time in 'non-clinical pharmacist work (i.e. dispensing as technical supply)'; 216 (16%) worked in other non-clinical roles and; 1053 (77%) were professionally satisfied., Conclusion: Measuring the pharmacist workforce based on registration data significantly overestimates the available clinical pharmacist workforce: 708 (44%) respondents were no longer working in the profession, were not mainly involved in clinical practice or were working in non-clinical roles. A significant re-professionalisation program is needed if pharmacists' unique knowledge and skills are to contribute to better healthcare delivery.

Objective: This study aimed to investigate neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) during late-gestation., Methods: A retrospective cohort study was conducted using linked records from the Women's and Children's Health Network in South Australia, Australia, including the Perinatal Statistics Collection and the Hospital Pharmacy Dispensing Records. Women were eligible to participate if they gave birth to singleton, live-born infants between September 2000 and December 2008 (n = 33,965). Women were excluded if they received a dispensing for antidepressants other than SSRIs (n = 93) or an antipsychotic (n = 81). We estimated odds ratios (ORs) and 95% confidence intervals (CIs) for preterm delivery, low birth weight, small-for-gestational age, neonatal hospitalization and length of hospital admission, adjusting for sociodemographic, lifestyle, and medical factors., Results: Two hundred twenty-one women received a dispensing for an SSRI during pregnancy, 1566 had a psychiatric illness but did not receive a dispensing for an SSRI, and 32,004 did not have a psychiatric illness and did not receive a dispensing for an SSRI. Compared to infants of women with a psychiatric illness but no SSRI use, infants of women exposed to SSRIs had an increased risk of preterm delivery (adjusted OR, 2.68; 95% CI, 1.83-3.93), low birth weight (adjusted OR, 2.26; 95% CI, 1.31-3.91), admission to hospital (adjusted OR, 1.92; 95% CI, 1.39-2.65), and length of hospital stay longer than 3 days (adjusted OR, 1.93; 95% CI, 1.11-3.36) but not small-for-gestational age (adjusted OR, 1.13; 95% CI, 0.65-1.94). Psychiatric illness but no SSRI use during pregnancy was only associated with an increased likelihood of neonatal hospital admission (adjusted OR, 1.21; 95% CI, 1.07-1.38)., Conclusions: These results add to the growing body of evidence of an association between SSRI exposure during pregnancy and a range of adverse neonatal outcomes, but the potential for confounding according to severity of underlying maternal psychiatric illness requires further investigation.

Objective: To explore pharmacists' awareness of Australia's health care reforms and their beliefs and attitudes about their current and future roles., Methods: Four focus groups were conducted with 32 South Australian pharmacists: two groups included community pharmacists and pharmacy owners; one included hospital pharmacists and another, consultant pharmacists., Key Findings: Four themes emerged: (1) poor awareness of health care reform agenda; (2) strong adherence to the supply model; (3) lack of appreciation of alternative models; and (4) communication barriers., Conclusions: Participants' low awareness of Australia's health care reforms and their expressed beliefs and attitudes to their current role in the health system suggest that they are not well prepared for the potential future roles expected of health professionals in the health care reform agenda., (© 2011 The Authors. IJPP © 2011 Royal Pharmaceutical Society.)

The aim of this study was to examine the effect of psychotropic medications (antipsychotics, antidepressants, anxiolytics, hypnotics and sedatives) on the risk of falls and fractures in a cohort of elderly people in South Australia. A retrospective cohort study was undertaken using the wave 1 (1992) and wave 3 (1994) data of the Australian Longitudinal Study of Ageing (ALSA). Persistent use of psychotropic medicines was defined as use of one or more psychotropic medications at both wave 1 and wave 3. A comprehensive list of potential confounding variables was individually entered into regression models to examine effects on risk ratios. The results showed that the use of psychotropic medications was associated with an increased risk of falls in females (IRR=1.47, 95% CI=1.31-1.64) but not in males (IRR=1.03, 95% CI=0.85-1.26). The use of psychotropic medications was also associated with an increased risk of a fracture in females (RR 2.54; CI 1.57-4.11; p<0.0001) but not in males (RR=0.66; p=0.584; CI 0.15-2.86). In both analyses, the body mass index (BMI) was determined to be the only confounding variable. After adjusting for BMI, the IRR in females decreased to 1.22 (95% CI 1.02-1.45; p<0.015) for falls and the RR decreased to 1.92 (p<0.015, CI 1.13-3.24) for fractures., (Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.)

Background: In Australia, brand substitution by pharmacists has been possible since 1994. There is no limit to the number of substitutions per prescription. Doctors have expressed concern that patients may receive a different product each time their prescription repeats are dispensed, which has the potential to confuse patients. It is unknown how often multiple substitutions per prescription occur., Objectives: We aimed to identify the number of switches per prescription for a range of medicines and to determine the number of different brand and generic products supplied on each prescription., Methods: Repatriation Pharmaceutical Benefits Scheme prescription claims between 1 January 2001 and 28 February 2006 were identified for atenolol, citalopram, enalapril, metformin, omeprazole, ramipril, and simvastatin. Original prescriptions with five repeats and all supplies dispensed were included. Switches were identified if a different product was supplied on consecutive repeat dispensings., Results: 533,279 original prescriptions were included. 488,735 (92%) had no switches on repeats and 37,513 (7%) had only one switch. Only 1% of all prescriptions had more than one switch identified on repeats, and in most cases only two different products were supplied. None of the prescriptions had a different product supplied on each dispensing., Conclusion and Implications: Multiple switches per prescription are uncommon and multiple different products are rarely supplied on repeats of the same prescription. The rules of the brand substitution policy appear to be adequate in allowing brand choice for patients, without leading to multiple switches per prescription.

Objective: To implement and evaluate a collaborative medication management service model., Design: Participatory action research., Setting and Participants: The study was conducted from March 1999 to March 2000; 1000 patients, 63 pharmacists and 129 general practitioners from six Divisions of General Practice in South Australia participated., Interventions: A collaborative service delivery model, involving a preliminary case conference, a home visit and a second case conference, was agreed through discussions with medical and pharmacy organisations and then implemented., Outcome Measures: Medication-related problems; actions recommended; actions implemented; and outcomes after actions taken., Results: Overall, 2764 problems were identified. The most common medication-related problem (17.5% of all problems) was the need for additional tests. Thirty-seven per cent of problems related to medicine selection, 20% to patient knowledge, and 17% to the medication regimen. Of 2764 actions recommended to resolve medication-related problems, 42% were implemented. Of the 978 problems for which action was taken and follow-up data were available, 81% were reported to be "resolved", "well managed" or "improving"., Conclusion: This implementation model was successful in engaging GPs and pharmacists and in assisting in the resolution of medication-related problems.