NEW PHARMACY PRACTICE REVIEW NOW AVAILABLE: ADDRESSING ELEMENTS FOR GOOD ASTHMA CONTROL

A new NPS MedicineWise educational activity has been launched specifically for pharmacists to help people achieve better asthma control. Around 50% of people with asthma live with poor control of their condition and consider this to be normal. NPS MedicineWise clinical adviser Dr Andrew Boyden says that studies have shown that up to 90% of people with asthma have incorrect inhaler technique*.
“Incorrect inhaler technique is associated with increased and ineffective medicine use which contributes to poor asthma control,” says Dr Boyden.
“Pharmacists play a key role in helping people get good control over their asthma, and the new Pharmacy Practice Review will provide up-to-date information based on the latest evidence and clinical guidelines.”

A recent survey by NPS MedicineWise** showed that over half of all respondents with asthma said they had experienced symptoms in the past four weeks, including wheezing, breathlessness and night waking.  

The latest NPS MedicineWise Pharmacy Practice Review, Asthma management: elements for good control, will help pharmacists to identify possible triggers that may affect asthma control, ensure people have correct inhaler technique and identify and explore strategies to improve asthma management.

Asthma management: elements for good control review is based on the new Australian Asthma Handbook 2014.

Participants in the Pharmacy Practice Review will be able to:

• Outline the symptoms of poor asthma control
• Identify and explore strategies to overcome poor adherence
• List possible triggers that may affect asthma control
• Assess and demonstrate correct inhaler technique
• Explain the importance of an up-to-date written asthma action plan.

Pharmacists who complete the Pharmacy Practice Review can earn 8 hours of Group 2 CPD (16 CPD credits) and will have access to up-to-date evidence-based information and clinical guidance and tools to guide conversations with people who live with asthma.
To participate in this activity register now at www.nps.org.au/pharmacy-practice-reviews. Other NPS MedicineWise asthma resources, including online information hubs for consumers and health professionals, are available at www.nps.org.au/asthma

2. TESTING FOR FATIGUE NOT NECESSARILY THE FIRST STEP: NPS MEDICINEWISE

Fatigue is a common complaint accounting for around 3-7% of all presentations to general practitioners. To help health professionals understand the limitations and appropriate use of diagnostic tests relating to fatigue NPS MedicineWise has launched a new program—Back to basics for fatigue: a diagnostic approach.

People presenting with fatigue are often sent for testing on their initial presentation—76% of GPs surveyed by NPS MedicineWise indicating they would always or often refer patients for pathology when they presented with fatigue for the first time. There is no specific test for fatigue so investigations need to be used selectively, keeping in mind the clinical context.

The new program from NPS MedicineWise is underpinned by Therapeutic Guidelines Limited’s* Fatigue: diagnostic approach in primary care. It provides a framework for assessment and diagnosis focusing on a comprehensive clinical history, targeted examination and judicious laboratory investigations.  While addressing more common presentations of fatigue, the program also refers to the various ‘red flags’ which may indicate more serious pathology.

NPS MedicineWise clinical advisor, Dr Andrew Boyden, says fatigue is common but can be difficult to define as the experience of fatigue can be different for everyone.

“Some patients refer to being ‘tired’, ‘sluggish’, ‘run-down’ or ‘lethargic’. It can be an enduring feeling of tiredness that may not be adequately relieved by rest or sleep,” says Dr Boyden. “Fatigue can often be managed by addressing a patient’s underlying causes which may be a combination of lifestyle, psychosocial and physical issues. It is also a symptom that may remain unexplained but in the vast majority of presentations is uncomplicated and self-limiting.”

Many patients expect pathology tests to be ordered by their doctors to investigate their fatigue. Fatigue was the sixth most common reason for pathology testing in 2011-12, requested in up to 70% of GP visits for fatigue with an average of four tests undertaken at a time. In a recent survey of 501 GPs, NPS MedicineWise found:

*  52% of participating GPs agreed or strongly agreed that patient expectation of a diagnosis influenced their decisions about the use of pathology tests to investigate fatigue symptoms 

*  76% indicated they would always or often refer patients for pathology when they presented with fatigue for the first time with no specific features raising suspicion of an underlying condition

*  47% always or in most situations order a diagnostic test for the primary purpose of patient reassurance.

While clinicians understandably will wish to exclude potential serious causes of fatigue, there are risks associated with over-testing.
“Requesting pathology when there is a low pre-test probability of disease increases the chance of a false positive result—with subsequent potential detrimental flow on effects—compared to when a higher pre-test probability of disease has been determined on the basis of clinical assessment,” says Dr Boyden.

“While serious conditions do need to be excluded, it is important to communicate with patients that they may not need pathology testing— at least in the first instance—and their fatigue may be addressed by managing lifestyle, psychosocial and physical causes. Fatigue is often not associated with underlying disease and may remain unexplained.”

Information about fatigue for health professionals and consumers can be found at www.nps.org.au/fatigue.