s Coles Pharmacy Expansion and the Arid PGA Landscape | 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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Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
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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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Coles Pharmacy Expansion and the Arid PGA Landscape

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.

It’s a bewildering and sometimes fast-paced environment in the world of community pharmacy.
And the convergence of Information Technology in the form of cloud computing and bricks and mortar retailing is gaining momentum.
A wake up call emerged recently when it was revealed that Coles was trialling interactive tablet devices in its Southland store in Victoria, to sell pharmaceuticals through the provision of information.

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The method of deployment is to attach the tablet to a retail product shelf and allow customers to operate the tablet to gain access to product information.

At the point of entry to the system, there is an offer to join the mailing list, presumably to be notified by e-newsletter about products, their information and new product releases.

Newsletter items can then be linked back to an interactive website that can further be linked to a smart phone.

It’s a neat and relatively inexpensive way to talk to your customers and patients.

It can also be a nucleus for a clinical pharmacist network to link in to enable suitable alliances to form up and create a viable information service network.

The current Coles trial has the tablet located in the analgesics section of the store, and allows consumers to gain more information on pain relief products, while at the same time provide live data and analytics to Coles management about what customers are looking at.
The convergence of online, bricks and mortar and mobile phone technology has been frantically developed since major retailers found a gaping hole in their sales volume (over 2010-2011) and looked for ways to plug the leaks.

It is no accident that Coles is experimenting with this technology and it is also no accident that their information service has been installed in the analgesic section of their test store, because their own research tells them that the lack of a suitable medicinal product information system is the only piece of the jigsaw holding back their dominance of this market.

It also highlights the poor performance of the Pharmacy Guild of Australia that has resisted encouraging the employment of information/clinical pharmacists, preferring to tie them to the dispensing process and gradually replace them with automated dispensing machines.
Other holes in the PGA system of destabilising other pharmacy organisations to prevent them from developing better alternatives are now coming home to roost, with the PGA having to fight on many fronts, wasting resources in the process.

Those resources could sustain other groups who could utilise the funds more effectively.

A classic example of PGA mismanagement is the current debacle surrounding consultant pharmacists and HMR payments.
Starting with a single product (HMR's) and a poorly designed umbrella group to represent the interests of consultant pharmacists (only two heavyweight shareholders – the PGA and the PSA) the association has hampered development of this clinical service, allowing the PGA to operate from a conflict of interest standpoint through funds negotiation contained in the various PGA/government community agreements.

Of course the consultant pharmacists were always going to be the poor cousins.
And despite the fact that some HMR’s may be borderline ethically, with doctors able to gouge extra funds for providing referrals to consultant pharmacists , additional to the fees paid for writing the referral in the first place.

Many new technology systems can prove disruptive and the Coles system may well be one of them as they are touching a raw spot in pharmacy, the provision of quality information about medicines.

I have often written about how assembly-line dispensing displaces the provision of quality information to patients because of the punishing pace and pressure of those assembly-lines.
I have also written about the many surveys conducted, highlighting the fact that patients want greater access to pharmacists for information services and also basic treatments of minor illness.
Pharmacy is vulnerable while it devalues the provision of information and allows Coles (and others) to exploit any loopholes that can be developed and expanded.

What can be done?

I would suggest:

1. PGA members call on their executive to resign to allow a new team to form up and lead appropriately.

2. Have a review of all other organisations that the PGA has a direct or an indirect interest in and set them free (the AACPA comes to mind).

3. Have an external auditor identify areas where conflict of interest appears among the many activities conducted by the PGA and have them eliminated.

4. Ask for transparency in regard to the commissions paid to the PGA for managing pharmacy grants.
An immediate use for these funds might be to pay off the over-run of dollars that have occurred through PGA mismanagement.
Because the grant commissions affect all of pharmacy, a transparent system be established as to what is the annual value paid by government to the PGA, how is the expenditure accounted for and what would be a fair method for any perceived “enemy” of the PGA to be able to apply for a legitimate grant and have a fair chance of receiving one.

Tragically, I believe that the PGA is on the road for the total destruction of professional pharmacy and the PSA, whether it likes it or not, is impotent to correct and provide any balancing processes.

A concerned pharmacist sent me the following note recently:

“Coles at Southland Victoria is trialling a tablet computer to help people "confused about pain relief". This featured in other news media yesterday. Whilst the idea of a tablet computer is great, it's an adjunct at best and is not substitute for a pharmacist. I feel that this tablet computer from Coles is pertaining to be an information source for people confused about their pain medication. It just relays the exact same information that is on the back of the packet. If Coles is serious about giving information about pain medication, then, why don't they employ a team of pharmacists to man a national drug information center? There are plenty of unemployed pharmacists in the cities that would jump at this chance? But no, Coles thinks that this tablet is better than speaking to an actual pharmacist? If someone is confused about pain relief, then, I think that they should always be advised to seek a health professional - at least talk to the local pharmacist? There was a Priceline pharmacy across the way from this store with two pharmacists there when I took these photos. I feel that patients should be directed there.

Why haven't the Guild attacked this action? Why is Coles enticing customers to use their app on a tablet computer instore rather than talk to their local pharmacist? Wouldn't this decrease business and profits for pharmacies who are members of the Guild? Maybe, it has to do with the Nurofen and Panadol that was right behind the Tablet computer. All forms of Nurofen for migraine, back ache, etc  -really. Did the Guild's cosy relationship with Reckitt Benckiser compromise the Guild duty for their own members who pay >$2000 a year for the privilege of Guild membership. Also, this could demonstrate that Coles is ahead of many pharmacies that spend time looking for snail mail PSA fact cards...?”

The question is asked about why Coles did not set up an information system through the use of a pharmacist or an incorporated pharmacist service.
I think the answer to that is because they did not see value in utilising pharmacists.
Consumers and other businesses have not yet understood that pharmacists and pharmacies are two different animals.
If a pharmacy will not invest in a structured information service it is assumed that it is not a valued service.
Consumer surveys tell us that pharmacy customers want this service and want to see it expand into other professional services.

If pharmacies can’t see the need and don’t value pharmacists who would provide it? And why should Coles invest in a pharmacist-backed service?

If there are pharmacies out there who would value an information service for their consumers please send me an email using  the address neilj@computachem.com.au .
If there are individual pharmacists or pharmacist-owned service companies that are likewise interested in providing such a service, please contact me on the same email address.
Maybe we can create suitable matches.

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Submitted by JamesT on Mon, 18/03/2013 - 19:58.

Strong words Neil, strong words. And rightly said. Pharmacy needs new leadership. A leadership that is united in its efforts to value all aspects of the pharmacy profession and to represent them fairly. I agree with you wholeheartedly that that the PGA should be audited and examined for conflicts of interest.
I think it is important that profession values the information that pharmacists provide. The best performing community pharmacies are and will always be those that are strong retailers - that have a very stout front of shop backed by personable, well-presented and knowledgeable staff. This is the first and foremost method to compete with the likes of Colesworth.

Those pharmacies that are soley relying on the dispensary script trade and do not invest in their F.O.S. & staff will suffer inspite of the 5CPA incentives as these incentives (as we have clearly seen) are/will be self-limiting. The Government will be looking closely at these costs. Pharmacy needs to free itself of these Government/PGA budgeted bonds and take steps to focus on the creation of firmer, less limited income streams that pharmacy can rely on well into the future.

Submitted by Kay on Mon, 18/03/2013 - 14:01.

The elderly who are most at risk of medication misadventure are the least likely to use the tablet computer. However as they are pensioners they are probably not Coles target market either.

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