s Is the dispensing process undervalued? | 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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Newsflash Updates for July 2014

Newsflash Updates

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.

read more
open full screen

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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Is the dispensing process undervalued?

Joseph Conway

articles by this author...

Joe Conway is an Irish born pharmacist who qualified in the UK in 1998.
After completing a residency in a hospital in London, he embarked on a 3 year locum stint that involved working all over the UK, Ireland, and Australia in over 350 pharmacies of all varieties (hospitals large and small, community, even a prison pharmacy).In 2002, Joe emigrated to Australia and worked in the Private Hospital sector gradually moving in to management positions with Slade Pharmacy where he developed a keen interest in Oncology services. In 2006, Joe took up a position setting up a Pharmacy service to a newly built Day Hospital in Frankston, Victoria. The Pharmacy now conducts over 40 clinical trials.
Joe is currently studying for a Master of Biostatistics to help him progress in the area of clinical trials, and think outside the square (or at least be left-field).

With all the talk in pharmacy media recently about expanding pharmacist roles within the healthcare team and various commentators now taking aim at the dispensing fee, many dispensary pharmacists are feeling a little unappreciated right now. There is a sense that the act of dispensing a prescription is undervalued and seen as a cost that should be reduced and the value of it is questioned by many commentators (e.g. serial pharmacy critic Professor of Health Economics Phillip Clarke). Dispensing is the most fundamental and one of the most profitable processes undertaken in pharmacy right now. You have to sell a lot of toilet rolls to make the same dollar profit as a patient electing to take the generic brand of Atorvastatin 80mg X30 instead of the Lipitor brand.

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Why is this process undervalued? Is it because we as a profession are seen to undervalue it? Or, is it due to some other extrinsic (to the profession) forces? I feel that some in the profession could give the impression that they undervalue dispensing.

For a start, offering scripts at less than $6 (i.e. less than the current PBS dispensing fee- $6.52) might give the impression that the current dispensing fee is too high. However, these low price scripts are often on high use products that are typically prescribed for patients of a demographic that the pharmacy wants to attract. An example of this is supplying antibiotic mixtures for kids at less than $6 per bottle. Here, the obvious quest is to attract new mothers to the pharmacy. New Mums (and most Dads) stay in a similar area for about 20 years and it’s worth offering the cheap price on products that they typically fill. You can win a very profitable long term customer and if they fill their basket up on the way out, then, the low prescription fee has done its job. Another example of a desired demographic is the 40-60 year old man who has had a heart attack. Being on 5+ medications can be very expensive if you’re not covered for concessional PBS benefit, so there is a desire for this demographic to shop around for the best prices. These are obviously very profitable customers with disposable income and the effectiveness of the cardiac blockbuster drugs means that they will probably need these medications for a long time. These two examples will hopefully demonstrate that the low dispensing fee on items priced <$6 per box on a valid script are on items where there is a strong demand for typical consumers of such products and as such the dispensing fee is lower than average I believe a means of attracting these customers to the pharmacy.

There are also pharmacies that advertise that they do prescriptions “fast”. This is a bit like the express lane in supermarkets. If you place a value only the speed of your dispensing, then in the minds of consumers, all that matters is how “fast” you are. You might have needed to contact prescribers or had an unusually large number of scripts in the past hour, but to the customer, if you are slow, then you are crap as you said that the most important thing is to be “fast”. Advertising yourself as “fast” has the potential to devalue the act of dispensing even if it is a valid marketing strategy in Australian and overseas pharmacies.

Some pharmacists see the point at which a pharmacist interacts with the patient as a good time to offer other products that might benefit the patient. If such a sale is clearly for the clinical benefit of the patient, then I see nothing wrong with this. However, if not done quite right, then this has the potential to devalue the dispensing process in the eyes of patients. An example of this was the “Coke and Fries” comment by Blackmores Chief Executive Christine Holgate in September 2011 that pharmacists could provide ''the Coke and fries'' with prescription drugs. It was disappointing to hear that this was what Blackmores thought of our dispensing process. Another example is when pharmacists push too hard to get patients onto the “pharmacy best buy” brands. Again, I think most people would rather support their local communities through choosing the pharmacy preferred brand, but, there are other reasons why people want the original brand names. A pharmacist giving a “slick spiel” during their customer interaction time on the benefits of generics can sometimes go too far making pharmacist look like used car salespeople and could in part devalue the valuable pharmacist patient interaction time at the point of dispensing.

The process of dispensing is one of the 3 fundamental processes in taking prescription medication. You see a doctor who writes you a prescription, you take the prescription to a pharmacy to receive the medication and, lastly, you consume the prescribed medication often in your residence. The dispensing process is fundamental to good QUM. Every patient has to do it and this is a valuable interaction point where problems can be identified and tended to in a cost-effective way. Even when there are robots doing most of the dispensing process (e.g. 10-15 years’ time), this process of giving a prescribed medication out to the patient should always be done by a pharmacist spending this time educating patients and being available to answer patient’s questions and allaying their fears.

The dispensing process can used to evaluate the usage of medication and help in patient education, but it’s only part of the story. There are a significant number of patients who get prescribed medication who never get their script filled in the first place or shop at multiple pharmacies. For many, they have scripts “just in case” and never use them. However, there are also people who refuse to continue taking medication due to side effects/cost/apathy/etc… and many of these won’t get detected in the pharmacy as they never take their script to a pharmacy in the first place. Working more collaboratively with doctors in GP surgeries is one way to try and tackle this. If a patient whom a GP suspects may become non-compliant sees a pharmacist within the clinic, then, maybe this interaction will have positive benefits in terms of quality-adjusted life years gained and overall savings for the healthcare budget? Sure, we need more verifiable research, but we are starting from a low base and surely there is room for growth in terms of jobs for pharmacists in this setting?

Saying that pharmacists should be allowed to work in a GP surgery is not saying that dispensing isn’t worth much. It is one part of a holistic process to ensure that patients end up with best outcomes for the least government spend. We are excellent at dispensing and it’s currently our bread and butter. There is room for growth there with Clinical Intervention, Drug Administration Aids, Medscheck, and ultimately HMR’s being part of this. However, for maximum benefit, I say that we should cast a diversified range of services. Working with GP’s in surgeries, HMR’s via direct GP referral are parts of this. Dispensing is and will always be part of pharmacy. If pharmacists want to expand beyond the dispensary, then, this is shouldn’t be a threat to dispensing. It should ideally be a complementary process and work in tandem with the dispensing process to both improve patient outcomes. However, the funding mechanism in pharmacy often pits different elements of our profession against each other. If we fund something, then inevitably, funding must be cut somewhere else. If pharmacists are funded to be in a GP surgery or part of an expanded HMR service, then, this money has to come from dispensing given the current system of funding. Unless there is a way of funding clinical services that don’t involve a cut to the dispensing fee, then I don’t see how expansion of pharmacist roles can be financed. I feel that this leads the current animosity between sections of the profession and the apparent disdain by some for the dispensing process…

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Submitted by James Ellerson on Mon, 04/03/2013 - 08:44.

Your concluding statement makes me very angry. My practice goes to the trouble of embracing ehealth and sending prescriptions to the interoperable prescription exchange yet my patients tell me their pharmacist doesn't use their escript sitting in the prescription exchange. This only leads to friction and disillusionment by doctors and patients that pharmacists don't care and are behind the times. This is what leads to animosity not between pharmacists but between pharmacists and their medical colleagues. How about advocating first of all that your lot enter the real world and start reading the barcoded scripts to save themselves some time.

Submitted by Kay on Fri, 08/03/2013 - 20:45.

James be careful before you throw stones. There are still many doctors handwriting prescriptions or using out of date software. This causes problems for pharmacists who won't be paid by Medicare for prescriptions which do not meet legal requirements or comply with the PBS. Pharmacists have been using computers for 30 years but many doctors have not even started. I suggest that you tackle the luddites in your own profession before criticising pharmacists.

Submitted by An early eScript adopted on Sun, 03/03/2013 - 17:37.

I have a very simple view Joseph. If our pharmacist colleagues do not very quickly embrace electronic prescriptions as a routine part of the dispensing process and download every possible script they can from the now interoperable Prescription Exchange Services they will do themselves and our entire profession irreparable damage which I suggest may be the final straw for Government to allow Pharmacies in Supermarkets. We really do need to move ahead with the times and embrace the new technology now available to us.

DoHA has supported the PES's to develop interoperability, most doctors are now sending their eScripts to a PES. But from what I have heard an awful lot of pharmacists are still wedded to manually entering scripts instead of embracing the new technology directed at minimizing errors and saving pharmacists time hence money.

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