Thread by @pharmerfour

There has been a lot of talk in the last few days about #CMI & information provided by pharmacists & GPs when new medicines are provided.

@GregHuntMP @LeanneWells63 @CHFofAustralia @MetherellMark

@ShaneJacks @topherfreeman @PSA_National @gigmoses @elliott_rohan

One of the points raised is that written information is needed to support the person at a time when they are being inundated with new information

This is no doubt true - something I regularly call for - but it is also not a surrogate for the clinical role a pharmacist undertakes

I tweeted about a recent clinical discussion I had with a person in my pharmacy who had recently been diagnosed with #rheumatoidarthritis

You can see the summary here

https://twitter.com/pharmerfour/status/1061180886563966976

You'll note that I don't mention the provision of a #CMI

It was provided, but it's not actually a highlight of the discussion. It was used to reinforce a few of the points I discussed, but as a clinical tool, it is actually not as useful as it **should** be

A number of people have noted that a #CMI is very long, full of jargon, & structured in a way that mitigates risk for the sponsor of the medicine, rather than providing real information that is useful.

An asset to "compliance" it is not.

I'm not aware of any studies on the matter, but anecdotally I've had a significant number of people who have had worse outcomes due to a mis-reading of their #CMI (20-ish years of practice & they build up in your memory, so I could be biased here).

These worse outcomes include anxiety over side effects;

misunderstanding the indication (This says it is for depression, but I have pain, not depression)

conflating specific advice about the individual with general advice from the document

Reinforcing a person's pre-existing fears about treatment

Focusing too much on potential side effects or trivial points, & using these to justify not utilising a treatment

Despite these failings, #CMI should still be provided in almost all situations, but it requires a discussion - it certainly doesn't **replace** a discussion, & shouldn't be a surrogate for a good clinical consultation with a person.

It also shouldn't be reserved for initiation of a medicine. Changes in doses, emergence of side effects, during a #MedsCheck - there are many times when a #CMI can be provided as a supportive tool

Talking is fantastic, but when you get home, much of what you heard is gone

The fact of the matter is, #CMI are far from perfect

They never will be perfect either, because there will always be disadvantages to a static piece of information

But we can make them better

I think we are about due to a new look at #CMI

I'm sure @GregHuntMP could find a space in his portfolio to fund a consultative review of the documents now, with aims to trim the fat a little, but also create a process that is flexible

Let's have #CMI that are electronic & editable

You're taking this sildenafil for pulmonary hypertension rather than erectile dysfunction? Lets delete that whole section...

Let's add a person's name (plus their GP & Pharmacist's name) to the document... and a date!

Let's present side effects in a realistic way

These ones are serious. They are always important, even if rare

These aren't common, but likely would only be annoying

These ones are common;

these ones are temporary;

this one makes your tears turn orange (yes, that's a real side effect!)

More importantly

HERE IS WHAT TO DO IF ONE OF THESE OCCUR

In summary, @GregHuntMP I look forward to seeing your letter to all pharmacists & medical practitioners about provision of information & #CMI

I'm sure it will acknowledge the shortcomings of CMI, but also that it is an important tool in provision of health information

But I also expect an announcement that there will be a consultative review involving consumers ( @CHFofAustralia ) pharmacists ( @PSA_National ) & medical practitioners ( @RACGP )

An opportunity to improve this resource. Let's make it happen.