s Building a Clinical Space- Privacy Without Heaviness. | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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News Flash

Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated

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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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Building a Clinical Space- Privacy Without Heaviness.

Neil Johnston

articles by this author...

Neil Johnston is a pharmacist who trained as a management consultant. He was the first consultant to service the pharmacy profession and commenced practice as a full time consultant in 1972, specialising in community pharmacy management, pharmacy systems, preventive medicine and the marketing of professional services. He has owned, or part-owned a total of six pharmacies during his career, and for a decade spent time both as a clinical pharmacist and Chief Pharmacist in the public hospital system. He has been editor of i2P since 2000.

You may be looking to establish clinical services offering for your pharmacy, but like many of our fellow-pharmacists you may have taken a “hit” in the cash flow area that may be causing concern and indecision.
There are few models for community pharmacy clinical service spaces, so if investment in this area is to occur, the spaces need to be generated with minimal cost and maximum effectiveness.
You are urged to carefully think the process through and gather as much evidence as is available for every input into a clinical space.
That includes colour schemes, range of furnishings, equipment, a departmental sign clearly identifying "Clinical Service", the price list of services on offer and a detailed marketing plan of how you intend to implement such services.
By not paying attention to every detail you may “trip” unnecessarily.
And that all has to be in place before the first patient can be recruited.

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If you already have a dedicated room for clinical interviews you do not necessarily have the best “clinical space” for the job.

Research indicates that for new pharmacy clinical services, a trust level has to build beforehand otherwise there will be patient hesitancy to enter a space that is isolated or “different” to what they have been previously used to.
Contrarily, they will also complain at the lack of privacy when a clinical service is not offered in appropriate surroundings.

AMA president, Dr Steve Hambledon asserts that pharmacy is not appropriate for the delivery of a clinical service (such as vaccinations), because it coexists with “toilet paper and toothpaste”. Such a derogatory statement has a faint element of truth within it, so it is up to dedicated pharmacists to prove him wrong by thinking through each step of a new clinical process.
I2P is already working on input for a regulatory and policy framework around vaccines and will be ahead of the action.
It is up to pharmacy to produce a quality service that will leave GP critics and others behind. That should not be too difficult and each success will create forward momentum.
A GP surgery is not necessarily convenient, economical or optimally serviced to proclaim that it is the ultimate environment.
It has always been a source of amazement to me as to the perceptions the medical profession have of pharmacy. It's obvious that they have never left their cloistered environments to see what happens in the real world of pharmacy.
They see everything in terms of a "turf war" rather than a supportive solution - they even think we are in need of a cold chain accredited system, a system we have had in place years ahead of GP's.

However, GP misinformed statement should not deter pharmacy clinical services. They may take a while to reach a true collaborative stage, but there's plenty to achieve until they catch up with reality.
However, we should always take on board constructive criticisms and above all, do our own research to ensure a clinical service adapts optimally within a pharmacy environment, and be prepared to change to suit the service. Not to bend the service to suit the clash of a dispensary production line.
That will definitely not work!

So the first clinical space that needs to be installed is a simple “counselling bench” about the size of a small cash-wrap counter where an initial patient engagement is able to be undertaken.
The purpose of this clinical station may be for booking patient appointments or greeting patient arrivals. It must be completely separate to the dispensing bench (but located conveniently nearby) and definitely away from any main counter so as to establish an initial level of privacy.
Above the counseling bench there should be a sign styled “Clinical Services” that should be in letters equal in size to the word “Prescriptions” or “Dispensary”.
You will note from the image illustrating a tripartite screen you can see objects that are diffused (which means patient faces would not be identifiable), a small degree of sound-proofing, and achieving “privacy without heaviness” level which is exactly the level that suits the bulk of pharmacy clinical activities (eighty percent).
Anything requiring stronger privacy would need to migrate to an enclosed room.

This type of clinical space reduces patient hesitancy. When a patient reaches the counselling bench, an invitation to enter a screened area will more easily be accepted by the patient.

The counseling bench is designed to slow down a patient who may have been recruited from the floor of the pharmacy. Unless you can engage them quickly and efficiently (and above all-interest them appropriately) you will have limited success because they are always in too much of a hurry to get somewhere.
To stage a slow-down you may need additional chairs adjacent to the counseling bench to encourage a “recruit” to sit for a while.
This may be reinforced with the offer of a cup of tea or coffee and you may then have created a slow enough environment to achieve patient engagement.
Once starting the detail (selling) process of a clinical service to a patient, there needs to be sufficient reinforcement written material prepared in advance for this specific encounter.
During the detailing, possibly towards the end of the detailing, the patient should be offered an inspection of the entire clinical space, accompanied by an explanation of how it works and what supportive systems are in place.
Clinical space is totally opposite to dispensing space in work flow, staff attitudes and objectives.
The clinical space is a quiet and subtle selling space while the dispensary is a flat-out production line space – never the twain shall meet.

Furnishings are important for clinical spaces and should be colourful, include a tasteful floor rug, comfortable and chairs and a coffee table.

This furniture should be in tasteful colours, finished in soft fabrics and be of a style that enables patients with disabilities to leave a sitting position with reasonable ease.

Do not try and utilise furniture that has traditionally been used in the prescription waiting area, which has generally been utilitarian, drab and uncomfortable.
Remember, that with our rapidly ageing population there will be some degree of disability or impairment no matter how healthy a patient may first appear, so a functional and comfortable chair is an imperative.

The more comfort afforded patients the more relaxed they will be and the more effective will be the outcome of any clinical interview.
These types of screens can be erected in front of a purpose-built enclosed room, or you can convert a cosmetic beauty room renamed as a dual-purpose “treatment room”.

A small desk suitable to operate a laptop computer should be included, but that is for clinical pharmacist use, before and after interviews-preferably not during an interview.
A computer should never be inserted between the interviewer and the patient because it immediately sets up a barrier to free-flowing conversation and a loss of eye contact, and no matter how momentarily, will constitute a break in communication.
If this happens too frequently a patient will get frustrated and irritated, and all that effort to recruit a patient in the first place, will be lost.

The above represents an economical and portable solution to building an effective clinical space that can be progressively tailored to the service offerings.

Think of the clinical service area as a “business within a business” and it will help to visualise and create the distinctiveness and flair that you wish to achieve.
As a separate business it requires its own branding, an identifiable space, and its own communications system that links into all other relevant pharmacy systems.
It requires its own distinctive fittings.
All the above details need to be incorporated into a separate business plan that includes a marketing plan segment identifying the type of services to be developed, the strategies to be employed and the budget required to achieve goals.

The clinical spaces outlined in this article can be built at a cost of $2,000.00 or close to that amount –it depends on how elaborate you wish to be.
The clinical spaces described are affordable and can be configured in a number of different ways that do not impose a major refit.
It can be used to advantage by eliminating a slow-selling department such as cosmetics. This would create liquidity and replace a low profit generator with a much better and more interesting segment of core business.
Anyone who would like more information, please contact me by email: neilj@computachem.com.au
or telephone: (02) 6628 5138

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