s Clinical Services For a Fee - Doctor and PGA perspectives | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


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

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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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Clinical Services For a Fee - Doctor and PGA perspectives

Peter Sayers

articles by this author...

Peter Sayers is vitally concerned about pharmacy professional practice - its innovation, its research and development, and its delivery to create an ongoing revenue stream. Delivery of healthcare is increasingly involved with Information Technology systems. All perspectives in IT must be considered for the impact on pharmacy practice and its viability.

A Roy Morgan poll conducted in Australia over the 9th and 10th May 2012 highlights a rating for ethics and honesty within the health professions.
Doctors scored an 83% rating (down 4% on the previous year), while pharmacists scored 88% (up 1%), and nurses were rated at 90% (unchanged) scored the highest.
This type of rating is usually fairly stable year-to-year with only minor movements up or down.
However, the 4% drop for doctors is significant and reflects a global pattern.
Something is obviously wrong.

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The online publication BMJ Open has published a recent study comparing doctor and pharmacist trust issue plus patient perceptions, and states:
“There is concern across a range of healthcare settings worldwide that trust in physicians is declining. Decreased trust may lead to lesser tolerance of prognosis uncertainty and an increased demand for tests, referrals and second opinions. Literature suggests that there has been a recent cultural shift towards decreased trust in, and increased questioning of, medical advice. We investigated the impact of varying prognosis and socioeconomic status (SES) on trust in physicians, and patient questioning of medical advice.”

With the rise in health literacy coupled with improved consumer basic education levels, health professionals should expect more questioning (rather than blind faith), because this is what is taught at high school/university and to always obtain a second reference before accepting anything as reasonable evidence.
It's also called taking responsibility for one's health through becoming an interactive patient.
If pharmacists do not succeed in being appointed a health mentor partner by consumers, future pharmacy will find itself in a "black hole" very quickly and will become financially unstable.
The fact that “holes” have been found in some doctor arguments to support a particular prognosis, has created a reduction in trust for those doctors, expanding through to the doctor-collective in general.

Coupled with the fact that medical fraud has become quite outrageous, (as reported in the Journal Nature”), which sounded an alarm in scientific and medical communities in 2011, regarding the number of research papers that had to be retracted.
The number had soared to over 300 in a single year.
These findings were often excused as simply honest mistakes.
But now the real truth is now coming out.
Greed, forgery, and downright lies are behind much of this scientific fraud. And the researchers who make up facts and figures to snag lucrative grants and commit these crimes usually get away with little punishment.
Credibility of doctor leadership has been severely damaged within the allied health community which has been left wondering what type of leadership role is being claimed (and developed) in the primary health care sector.

The BMJ Open concluded in their study regarding physician trust:
"Blind trust in physicians remains strong in older participants, participants who perceive their prognosis to be uncertain and a proportion of lower socioeconomic status (SES) participants. This is important for practitioners in terms of patient agency and points to the importance of moral and ethical practice. However, physicians also need to be aware that there are a growing proportion of patients for whom trust needs to be developed, and cannot be assumed."

Pharmacists have noted a similar pattern within their own patient community but have been more embracing in the exchange of information with patients, particularly in the areas of medication information provision and the offering of price choice with generics.
My belief is that this has been the main contributing factor in pharmacist increased rating, as measured in the Roy Morgan May 2012 poll.
Patient support up to now can also be measured in the response rate to the various petitions that the PGA have organised in past years – those petitions that have stirred governments to afford protection to the pharmacy profession in recognition of the consumer trust that has been earned by sheer hard work by individual pharmacists.

In the BMJ Open” conclusion, it is noted that trust remains strong in older participants and a proportion of lower socioeconomic status participants.
To earn the continuing right to act as a patient’s agent, there is a need for stronger efforts in moral and ethical practice.
This applies equally to pharmacists, not forgetting that a patient may see a pharmacist through visiting a pharmacy up to twelve times in a year (original prescription + five repeats + renewal). In that time they may only see their doctor twice, depending on general health, number of prescription items prescribed and their various expiry dates.

Standing back from the “assembly line” of prescriptions, it is obvious that more use needs to be made of the opportunities that are presented on each patient visit, and that programs should be created to ensure that each patient would give an optimum rating for pharmacists and the pharmacy as a whole.
And this is the problem.
Few initiatives have been developed to create an optimum design for the delivery of prescriptions and associated professional services. It seems everything has to be stuffed down the same channel and to do more with less.
Our PGA pharmacy leaders need to be strongly censored for allowing this mess to occur.
In fact they actively oppose the development of fee for service clinical offerings - a very strange policy and one that deserves universal condemnation from pharmacists.

In a recent edition of Pharmacy News, Kos Sclavos is reported as stating:

“Austerity measures being rolled out in Europe show that governments will cut funding for ‘nice to have’ programs including those paying pharmacists for services, the Pharmacy Guild of Australia believes.
Speaking at the Pharmacy Business Network event in Canberra, earlier this month, Kos Sclavos, Guild national president, said claims that pharmacy should adopt a fee-for-service model, was “the big myth of our profession”.
He told delegates that pharmacy services accounted for 7.3 per cent of total remuneration for the profession in Australia, and warned that the governments could cut back on funding them in difficult economic times.

“We see a lot of [pharmacy] leaders professing that we need to move to a services model,” he said.

“[But] if there’s a lesson with the difficulties in Europe, [it is that] whenever you have professional programs... when times are tough these ‘nice to have’ programs, as they call them, get cut.

“It’s not like dispensing, where the governments need dispensing services from pharmacists.”

Under the Fifth Community Pharmacy Agreement arrangements, pharmacists have been able to claim Pharmacy Practice Incentive (PPI) payments for signing up to programs under the agreement.”

Well there’s a lot of political hogwash contained in that Sclavos view of the world – which is "shonky" at best.
He uses recent austerity measures to support a non-evidenced base claim that the first services to be cut in difficult times will be fee for service programs.
The reality is all programs will be cut and Sclavos has been opposed to paid clinical services for as long as I can remember.

Dispensing is part of the PBS program, and dispensing is no different to other services. It does involve dispensing fees, and last time I looked that is a fee for a service.

Few pharmacy owners at the moment would say that they are not under pressure because of Guild/Government negotiated PBS rules coupled with austerity measures.
The reality is that government will not radically tamper with any service that will lose votes.
If a pharmacy fee for service activity is valued by the general public, it will definitely survive.
The PGA opposition to paid clinical services has been known for at least a decade, possibly longer. And it is also related to government grant management exclusively under control of the PGA.
To maintain this lucrative income stream (10% of the gross value of all grants) the PGA has to toe the government party line. That creates an unbalanced system not in the interests of all pharmacists.
It’s why the PSA is always in disagreement with PGA clinical policies because they have to hold their hand out if they need a grant to pilot pharmacist clinical services – and it’s never forthcoming!

Sclavos also states that pharmacy services accounted for 7.3% of total pharmacy remuneration.
I see that as a reason for expanding market share and developing programs and investing grant monies to ensure that happens – not a reason to pull back to the grind of ever-increasing numbers of prescriptions with poor returns.
Shouldn’t we all be looking for a way to improve community health through methods not involving the use of drugs and their associated side-effects?
They do not contribute to health quality and the quality of life in general.

To acknowledge the real value pharmacists can provide, an integrated service involving patient mentoring in diet, exercise, preventive medicine and mainstream medicine – there has been no PGA support for the real issues in pharmacy.

That would require a substantial share of grant monies for the PSA and a concurrent transfer of influence because the PGA is more directed to the business elements of pharmacy, which they have failed to protect.

The true vision for pharmacy is lost in PGA executive greed and the persistent grab for power. They do not represent all pharmacists, yet have a disproportionate say in where pharmacy’s direction lies.
Unless this is changed we will see many areas of pharmacy hived off into hostile territories, chief among them being supermarkets.

Addressing a hastily-assembled Pharmacy Business Network to deliver negative clinical service messages to the party faithful is a wasteful exercise and demeaning to those who have a competitive and better vision.
PGA influence and support will continue its downward slide until visionary members do something about it.
The current mob are too divisive – always have been and always will be.

The reality is that paid clinical services is the way of the future for pharmacy.
They help to balance out the mix of activity in a pharmacy environment, offer different employment opportunities to a range of pharmacists, they are self-sustaining and do not rely on a PBS stream of funding.
The PGA has lost relevance and trust. The PSA could fill the breach but is hampered by not having proper access to grant monies.
The way to restore the correct balance in pharmacy is to get rid of the current PGA executive and replace them with suitable leaders that at least have a professional vision.

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