s Clinical Pharmacists Developing Around the World | I2P: Information to Pharmacists - Archive
Publication Date 01/12/2009         Volume. 1 No. 7   
Information to Pharmacists


From the desk of the editor

Welcome to the December 2009 edition of i2p - Information to Pharmacists E-Magazine.
When i2P first began in February 2000, it was decided that a fortnightly publication might prove to be the optimum publishing cycle.
This thought was soon dispelled as it was found that having sufficient content to maintain this cycle became a problem.
Oh for those quieter times!
The cycle then became monthly and has been maintained up to now.
The problem is now coping with the volume of news and opinion that is generated on a daily basis.
Very much the reverse of the year 2000 - a statement for our time and how the pace of pharmacy life has increased.

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For some pharmacists the truth will be ‘inconvenient’. WHY is it so??

James Ellerson

Sir Winston Churchill said “Truth is incontrovertible, malice may attack it and ignorance may deride it, but, in the end, there it is.”
Elvis Presley said “Truth is like the sun. You can shut it out for a time, but it ain't goin' away.”

At the PAC 2009 Conference John Menadue’s forthright messages made it abundantly clear that the sun was shining very brightly indeed.
Here are the ‘message sticks’ that resonated with me:

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About that "Un-Invitation"

Dr John Dunlop (PGDipPharm, MPharm, DPharm(Auck), FACPP, FNZCP, FPSNZ, MCAPA)

It was interesting reading John Menadue’s speech given at the Pharmacy Australia Congress in Sydney in October.
It was even more interesting to read of the UN-invitation by the Queensland branch of the College of Pharmacy Practice and Management, the stance taken by the Pharmacy Guild of Australia and the Pharmaceutical Society, to support only pharmacy activities provided from within a community pharmacy.
How draconian is that?
Research has demonstrated, as has the low uptake of new professional services from within a community pharmacy, that the existing community pharmacy model is not compatible with the implementation of these new professional opportunities.
The two major arguments put forward are ‘lack of time’ and ‘lack of funding’.

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A Green Pharmacy is Gold

Neil Retallick

Simon Divecha, Director of GreenMode, a consultancy that assist business and people to find their carbon and sustainable advantages spoke at the recent Pharmacy 2009 Conference.
Simon has assisted businesses including BP Solar, Origin Energy, Lend Lease, ANZ and IAG.
His challenge to community pharmacy is to identify and take advantage of the opportunities that exist for businesses that have such close relationships with their local communities.

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What are we doing to ourselves?

Heidi Mahon

Over the last months, I've noticed the position taken by both the Guild as well as individual pharmacists on our on-line forums.

In his recent address Mr John Menadue poses the question - are pharmacists the most change-resistant health profession?

And if so, what is our future likely to hold?
What can we do about it?

Personally, I have to agree with him - if we as a group - and not just the Guild, DON'T take innovation as a prerequisite for how we practice our profession, then in 20 years time, what will we have left?

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Picture - the wood for the trees

Pat Gallagher

Another year has gone by and what have we done with technology in the health sector?
A good question that deserves a long and detailed review as a written dissertation by somebody learned and influential in health informatics, government, consulting or from the many agencies, departments and committees engaged in delivering e-health service to the Australian public; notably as a value proposition for the tax payers in the greater voting public cohort.

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Advancing Self Care

Neil Johnston

Imagine a pharmacy that had a range of eye catching kiosks that utilised easy to use touch screen technology.
Not passive kiosks, but kiosks that are interactive with customers/patients to efficiently provide a perceived need.
It’s not a new idea, but the marketing of health care through kiosks certainly represents an organised method of transferring information to customers/patients and assisting them to make good health decisions.
One current form of kiosk that is beginning to take hold in Europe and the US is the vision kiosk.

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Wind Farm will Power Sydney's Desalination Plant

Staff Writer

Source: AAP NewsWire

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Communications Technology - a nudge from the big end of town

Staff Writer

National Health IT assumed prominence recently when the National Business Council of Australia wrote directly to prime minister, Kevin Rudd, urging him to create a focus on communications technology and to invest appropriate funds.
I wonder if they were aware of the organisational performance 0f NEHTA and their inability to date, to actually deliver suitable infrastructure and systems.
And with $'s millions already wasted by NEHTA I am sure there is hesitancy by government to spend even more, given the dismal track record to date.
Health communications is stuck in a deep groove.
But it is interesting to note that the Business Council of Australia see productivity and investment opportunities in health if only the primary health players could integrate better and talk to one another.
Shared health communications underpins this potential benefit as the many writers for i2P have continually pointed out.
With the big end of town taking more interest, maybe government and health professionals can align themselves more fluidly.
A read of David More's blog article from a NEHTA insider in this edition of i2P, leaves you still wondering how an alignment can take place without removing the NEHTA structure completely.

Health info needs urgent technological injection

Source: Industry Search -24/11/2009


Read the BCA letter in full here

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Powering up by osmosis

Staff Writer

An unusual form of renewable energy has emerged recently in a novel format involving the use of fresh water and salt water interaction across a membrane that creates osmotic pressure.
This pressure has been demonstrated to be able to drive a turbine that can produce an electric current.
Osmotic pressure is well known in medicine with adjustments having to be made to eye drop and injection formulas to minimise the pain associated with the administration of these medicine forms.

The process is a more controllable form of natural energy when compared with weather-dependent versions of energy generation (solar, wind, tidal etc) and has a reasonably small and discrete footprint in the environment.
With a bit of imagination it is not too far of a stretch to have the salt water filtered through another form of membrane to create fresh water to be recycled within a closed system.

Norway tries osmotic power to harnessing power of salt

Source: Industry Search


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Insuring the Disabled

Staff Writer

Prime Minister Kevin Rudd is to be commended for the initiative in having a look at the feasibility of creating a no fault disability insurance scheme.
Disability can cause disaster to any family structure and can be a constant drain on financial resources that can add to further stresses up to, and involving bankruptcies.
By putting in place a proper financial underpin, each family member is enabled to be productive and self-sustaining. This can create a net gain to the taxation base when viewed globally, to include service providers and industries that can feed off that activity stream.

PM calls for national disability reforms

Source:DPS Guide to Aged Care


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Should patents apply to the natural world?

Staff Writer

I can't but help wonder if the move to be able to patent all things natural is a smart move.
Take for example the Neam tree that grows wild in the northern part of Australia.
The leaves of this tree make a great insect repellent with no known side effects.
An entrepreneurial Australian a few years back, decided to grow these trees and was surprised to have legal documents served on him claiming royalties and damages from some obscure US company that had registered a patent for all things Neam.
Unfortunately, there was no legal defence for the Australian grower.
Now there is an outcry by vested interests because the Australian government has resisted pressures to allow the patenting of human genes.
All sorts of calamities are therefore predicted for the local biotech industries.
But I wonder if these claims will prove to be valid?

Follow the debate in this article:

Ban drives 'biotech industry to its knees'


Source: AAP

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Public Hospitals - Time they were fixed

Staff Writer

Queensland Health struggles through another drama after using instruments that had been used on patients and left unsterilised.
But it's not just Bundaberg Hospital that is sick - the entire Australian hospital system needs a radical overhaul.
The Rudd government had promised to "fix" the problem after taking office, but so far has not made any noticeable progress.
Read about the latest problem.

Qld Health cleaning up after dental sterilisation scare

Source: ABC Online


By Chris O'Brien

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Patient uses initiative to attract nurses

Staff Writer

If anyone has ever been a patient in a hospital and tried the buzzer to get assistance from a nurse, then here is a new innovation to get attention.
Not that the nursing fraternity should shoulder the blame.
It's the politicians and the lack of political will to solve this issue and many others.
Congratulations to the patient and his initiative in dialling triple O.
Read the full story here:

Man rings triple-0 from hospital bed

Source: ABC Online

by Cate Grant


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What's good for climate is good for health

Staff Writer

Health professionals from around the world are slowly waking up to the fact that climate change can induce adverse effects on health.
At i2P we have been carrying messages for just on two years, regarding climate change effects, including research reports from our own writer Con Berbatis, in the hope that official pharmacy would see the need and develop policies and strategies for pharmacists to adopt.
Now, with the formation of the International Climate and Health Council a recognised forum is available to be addressed.
Will pharmacists be given a seat at the table?
Perhaps the Pharmaceutical Society of Australia should find out.

Health Professionals Around The World Launch The International Climate And Health Council

Source: Medical News Today


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Ageing slowly and safely

Staff Writer

The ageing process is relentless with function loss noticeably diminishing over the age of 60.
Supplementation of nutrients holds one key to slowing down some of the processes, in particular the loss of muscle mass and the subsequent aches and pains that follow as the skeletal system is no longer held together in an optimum manner.
This process can be a contributor to falls and more serious damage.
Not being able to adequately stay on your feet as you age, robs you of your independence.
It would seem that a strategy of slowing down slowly might be prudent for the age demographic entering retirement - the "baby-boomers".

Antioxidants could help preserve muscle strength

Source: Reuters Health
By Marilynn Larkin

Found at this link

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Are we planning for future skill shortages?

Neil Johnston

National Seniors Agency have published a report indicating that Australia will have a shortfall of 1.4 million workers by 2025.
This shortage will also be reflected in the profession of pharmacy.
It is pointed out that a smart move would be to match an improved workplace to match specific requirements for mature-aged employees and thus retain them for longer periods..
APESMA has recently published an online survey in an endeavour to poll employed pharmacists on the issues that affect them specifically. Obviously, this is a move in the right direction, and much of what they are polling has a direct relationship to mature-aged employees.

So what is community pharmacy doing to retain their senior pharmacists?

Very little, it seems.

i2P asked Mark Coleman to comment and his commentary appears below the news item:

Comments: 1

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Clinical Pharmacists Developing Around the World

Staff Writer

articles by this author...

Editing and Researching news and stories about global and local Pharmacy Issues

Globally, a small subset of pharmacists is beginning to emerge to provide direct primary care.
They spend time with the patient - time that doctors are unable or unwilling to spend.
Concentration is focussed on the patient receiving appropriate medication, providing motivation and direction for exercise and ensuring proper dietary intake and control.
Delivery of these services is performed as part of a team.
In the example that follows, the team comprises a physician, a case manager, a nutritionist, a social worker, and of course, a pharmacist.
One of the writers for i2P, John Dunlop, provides a similar service in New Zealand.
If you haven't caught up with his interesting articles, then it is time for you to do some homework.
This type of clinical practice is actively discouraged in Australian community pharmacy because the Pharmacy Guild of Australia appear to find alternative forms of pharmacy practice as being competitive to a community pharmacy offering (rather than a logical extension and a core business element).
There is nothing to stop a pharmacist developing alliances with medical centres, GP super clinics etc, but in so doing there is no organised group to represent the political elements of such an alliance.
APESMA, the pharmacy trade union, has insufficient numbers and clout to assist.
The Pharmaceutical Society of Australia at this point in time, is only now developing the political will and expertise to assist clinical pharmacists.
For the moment, PSA appear to be grafted to the rump of the PGA and willingly or unwillingly follow instructions.
They must bide their time.
For all its experience, money and power the PGA seem blind to their alienation of the majority of individual pharmacists, heaping scorn on their aspirations in terms of career direction and income building.
They do have one point however, in that it takes a developed infrastructure to deliver any health product. The PGA does have infrastructure, but the delivery pipes are bent to ensure only "top down" services will fit, and the saddest aspect of this attitude is that this eliminates any Australian branded initiative.
Note that apart from FRED dispensing system, all aother initiatives appear to be overseas based.
The stifling of Australian pharmacist initiative is something that the PGA must bear full responsibility for.

Clinical pharmacists can fill in healthcare gaps
By Karen Ravn
Source: Los Angeles Times

With the time often not available to physicians, they answer questions, give exercise and nutrition tips, offer encouragement and, most important, build trust.

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"When he arrived for his first visit, the 55-year-old diabetic had no idea what constituted a healthy diet, says pharmacist Steven Chen.

"He ate two or three dinners a night, such as two whole pizzas about an hour apart." And he didn't know how to manage low blood sugar attacks. "He would eat an entire pie or cake instead of the recommended one serving of carbohydrate every 15 minutes."

Not only did Chen advise his patient about good nutrition and exercise, he stressed the importance of taking his medications every day exactly as prescribed. For instance, the patient had been injecting insulin deep into muscle instead of into the fat layer under the skin and had also been switching injection sites between his upper arm and his abdomen. Both interfered with the effectiveness of the insulin.

The patient had a lot to learn, but he was an excellent student, and in their weekly visits, he and Chen became true partners in his healthcare. And it paid off.

"The patient lost about 15 pounds," Chen says, "by exercising daily and cooking for himself. He even grew his own organic vegetable garden." And after almost two years, the patient was able to control his blood sugar with a single pill (metformin) and stop taking insulin completely.

Chen is not a typical pharmacist perhaps, but he is one of a growing subset. Called clinical pharmacists, these pharmacists provide direct care, using their expertise to ensure that patients receive the most appropriate medications and that they take them properly. These professionals often spend time with patients that physicians can't.

Chen, an associate professor at the USC School of Pharmacy, practices at the JWCH Institute, which provides healthcare to a poor, homeless, under-insured population in Los Angeles. There, he's a member of a team that includes a physician, a case manager, a nutritionist and a master of social work.

Chen is also faculty co-chair of the Patient Safety and Clinical Pharmacy Services Collaborative, a national project under the Health Resources and Services Administration that is working to integrate clinical pharmacy services into the care of patients with chronic diseases.

Evidence shows that when clinical pharmacists collaborate with physicians, they improve health outcomes. And with their extensive knowledge of available drugs, pharmacists can help to save money by using the most cost-effective ones.

"Traditionally, pharmacists have not been seen as caregivers, says Dr. Paul Gregerson, chief medical officer for the institute. "But these days, they fill a gap that has been left in the current healthcare system where physicians are so rushed."

It's routine at the institute for physicians to "pass on" some of their most difficult patients -- i.e., patients who have had the most trouble controlling chronic conditions such as diabetes and high blood pressure -- to the care of the pharmacists.

Sometimes patients are initially unhappy with such referrals, Gregerson says. "They'll grumble, 'Oh, I've been sent off to a pharmacist.' They don't realize it's the best thing that could happen to them."

Pharmacists review the patients' medical and medication histories, evaluate their drug therapy (changing it if necessary), order routine lab tests and monitor medication compliance. Best of all, perhaps, the pharmacists teach and encourage the patients, empathize with them and build their trust.

"They may be afraid to tell their physicians they're not taking all their medications," Chen says. "But they'll tell us."

Pharmacists see the patients once a week until they reach their goals, when their physicians take charge of their care again.

"They come out different than when they went in," Gregerson says, "better educated, better able to understand and contribute to their own care. . . . It's like a transformation."

A study currently under review for publication found that diabetes-related health outcomes are significantly better in clinics that integrate clinical pharmacists into their practice than in clinics that do not.

More than a decade ago, Brigham and Women's Hospital in Boston cut the number of adverse drug events in its intensive care unit by nearly two-thirds simply by having a pharmacist make patient rounds with the ICU team and advise physicians in prescribing medications. Not only was this a boon for the patients, but the hospital estimated this practice could reduce costs by $270,000 a year.

But Gregerson says clinical pharmacy is just now coming into its own because doctors have so little time to spend with their patients, and pharmacists can help fill the gap that leaves.

"Necessity is the mother of invention," he says. "And people are dumbfounded sometimes when they learn what these pharmacists can do."

He adds: "You're going to hear about clinical pharmacy a lot in years to come."

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