s The Great Debate - an informed comment | I2P: Information to Pharmacists - Archive
Publication Date 01/04/2010         Volume. 2 No. 3   
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Newsflash Updates for April 2010

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Regular updates from the global world of pharmacy.
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Audit Your Future

Neil Johnston

Given the current climate regarding the PBS, now would be an excellent time to audit all your business processes and develop strategies to overcome imbalances that are occurring and will continue to occur for some time.

A specific area of audit is the prescription $ value as a ratio of total sales.

This index has been drifting out of balance for some years now so those pharmacy managers who have become complacent about this index will have to work out a quick correction.

Always in times of political pressure on PBS prices, pharmacists have expanded their commercial sales.

However, competition is so tough between the major retailers and warehouse style pharmacies, it is hard to find a niche to compete in.

But there is always a solution - find it!

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The Great Debate - an informed comment

Peter Sayers

Following on from the Rudd/Abbott debate on health reforms a great deal of expected commentary resulted.
One of the better versions was published in theage.com.au and is found at this link:
http://www.theage.com.au/opinion/society-and-culture/health-system-is-more-than-just-hospitals-20100324-qwmg.html#comments
The article was written by Trevor Carr, who is chief executive of the Victorian Healthcare Association, that represents public hospitals, rural and regional health services, community health services and aged-care facilities in Victoria.
He states:
"The focus on beds and waiting lists ignores the role of primary care.Reform should move the health system from its current simplistic emphasis on hospitals and waiting lists to a system of interlinking elements that include acute care, primary care, early intervention, health promotion and illness prevention."

That statement is so sensible it is hard to think in any other terms. When Nicola Roxon first took up her position as Minister for Health and Ageing she came out in strong support of prevention, which meant a large slab of primary health care that pharmacy expected to be part of.
Her first foray was to establish GP super clinics.
They have been progressively introduced, but establishment costs seem to be a problem.
Also, the role of pharmacy within these clinics has never been properly negotiated or thought through.

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For Sigma, Time is Running Out

Peter Jackson

Siege mentality seems to have paralysed senior managers and executives at the troubled Sigma Pharmaceuticals, the Melbourne based pharmaceutical wholesaler.

On the 19th March 2010, Sigma chairman John Stocker prepared the market for a shock prior to when it was expected to release its results a week later, but then subsequently delayed until March 31, 2010.
The results are expected to show a write down of all company assets to bring them into line with reality. Share trading remains suspended since February 25, 2010.

As recently as September 2009 Sigma gained an ASIC clearance to raise money without a full cleansing statement and enquiries are being made as to what part the company auditors, Price Waterhouse Cooper, played in this clearance.
Sigma raised approximately $290 million at that time.
The longer Sigma delays in giving a full explanation of its finances, the more the market will speculate and worst-case scenarios will continue to emerge.

The market was looking for a profit of about $92 million, but this year it will lose at least $150m after some $250m in goodwill impairment charges.

Goodwill is the amount paid over the book value of the assets.
It works if you generate better profits from the assets, or big brand names are involved, but it is not an asset in the conventional sense of a cash-producing item.
Market analysts have pinpointed three “black” holes in the company’s operations, which in combination may have tipped the company into a financial crisis.

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Location Rules Dented

Peter Sayers

There has to be something wrong when one-third of a local community signs a petition to get something done.
Such was the case in the Victorian town of Colac when three local women decided that the service from the two local pharmacies (having a common owner) had dropped to an unacceptable level, and that prescription prices had also reached an unsupportable level.

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Primary Health Care Organisations - What's in it for Pharmacy?

Neil Johnston

The Pharmaceutical Society of Australia (PSA) recently criticised the Pharmacy Guild of Australia (PGA) for not being open in their negotiations involving the Fifth community Pharmacy Agreement, after it discovered that professional service funding was being “skewed”.
As a result the PSA entered into direct discussions with government to claw back some of the funding the PGA was directing towards eRx systems in the guise that this was a professional service (but was really all about gaining ongoing revenue for the PGA executive).
The PSA was able to alter the balance towards true professional service activities and in so doing, showed an initiative that indicated that it would be involved in the leadership of the pharmacy profession.
After all, it does represent all pharmacists.

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The Other Side of the Counter

Peter Sayers

Consumers of pharmacy services are becoming more vocal in specifying the type and quality of service they require.
And they are making their demands felt, both individually and collectively.
Earlier this month we saw the community of Colac in Victoria rise up against a repressive business model that was being delivered – poor prescription service and poor prices.
Now we are seeing the Consumer Health Forum organisation raising concerns in a discussion paper just released, about the uneven delivery of services under the Fourth Community Pharmacy Agreement (4CPA) and they are asking for greater accountability under the 5CPA.

Comments: 1

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Pharmacy and the new health reforms.

Staff Writer

Health reforms proposed for implementation in mid-2010 focus primarily on doctors and hospitals.
For the moment it is difficult to see where pharmacy will fit in, and more importantly whether pharmacy will be ready to fit in.
The PSA has hinted that it has had some input with government and has stated it is developing a green paper, but unless it changes colour quickly and becomes a white paper, it means that pharmacy will have little to offer government.
The fact that the PGA was quick to jump in and identify eRx as a major pharmacy contribution belies the fact that it is a system deficient in some standards and because of that, will never be accepted by other health professions if they were to be involved with it.

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NZ and Australian pharmacies have similar problems

Staff Writer

It would seem that pharmacy in New Zealand has a lot of similarities to Australia as the following news item details.
Surely the message must get through to the decision-makers sooner rather than later?
Health programs in both countries generally have the feel of being pressure cookers about to explode with neither government seeming to have the political will to take the first simple steps i.e. actually make a decision

Source: Voxy News EngineNZ
NZ Pharmacists Can Fill Gaps To Help Reach Health Targets

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Cold Hands & Feet - It's not just an NZ problem

Staff Writer

Ever since I have known my wife, she has complained of cold hands and cold feet.
I am pleased to find that the Kiwis have discovered a reason for this.
However they think the problem is confined to Kiwi women, but I am able to tell them the problem is already existing across the Tasman.
However, the problem does have its serious side, so the story is well worth following: 

Source: nzherald.co

http://www.nzherald.co.nz/health/news/article.cfm?c_id=204&objectid=10634773

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Aged Care Reforms - All Talk and no Action

Staff Writer

Reform in health care seems to be an intractable problem.
The pace at which it is being introduced means that aged care facilities as we know them currently will collapse.
What then happens to the most vulnerable section of our ageing population?
Pharmacy has an ability to generate a “pharmacy in the home” program, but there is no coordinated effort to start this type of program. 
Instead, there are too many power plays within pharmacy treading on boundaries between the profession and the physical infrastructure.
Compounding the problem further is a grab for “turf” between the professions.
The patient is way back getting lost in the sunset.
But optimism still exists.

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World first in preventing eating disorders

Staff Writer

The only eating disorder prevention program in the world to show long-term success when trialled on early teenagers has just been released by the Flinders University School of Psychology. Media Smart is an eight-lesson program that focuses on the manipulation of images in the media, building self-esteem and teaching young people how to analyse and challenge media messages.

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Compound screening for drug development made simpler

Staff Writer

The identification of compounds that could be promising candidates for drug development has become easier following research by the Walter and Eliza Hall Institute’s medicinal chemistry group.
Dr Jonathan Baell
and Dr Georgina Holloway have developed a series of ‘filters’ that can be used to weed out those molecules likely to come up as false positives when screening a chemical library for compounds that could be useful in drug development.

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Scientists in hot pursuit of first new drug for global killer in 50 years

Staff Writer

Researchers at the University of Sydney's Centenary Institute have announced that they have made an exciting discovery that could lead to the first new drug for Tuberculosis (TB) in almost 50 years

Dr Nick West, of the Mycobacterial Research Group, is looking at the genetics of TB in the hope they will reveal a way to reduce the impact of one of the deadliest diseases in the world.
Dr West said when someone is infected with TB they either become sick immediately or the disease stays inactive.
"Unfortunately, the antibiotics we use to fight TB aren't effective against latent TB and can only be used when the disease becomes active," he said.
"This is a major problem as 1 out of 10 people who have latent TB will develop the active disease, becoming sick and contagious."

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New clinical guidelines to prevent cerebral palsy

Staff Writer

A University of Adelaide researcher has announced new national guidelines recommending that women at risk of early preterm birth use magnesium sulphate to protect their babies from cerebral palsy.

Professor Caroline Crowther from the University's Discipline of Obstetrics and Gynaecology and the Robinson Institute says the clinical practice guidelines are based on overwhelming evidence over the past 14 years that magnesium sulphate is effective in protecting the fetus.

"Five trials, including one funded by the National Health and Medical Research Council, confirm this finding," Professor Crowther says.

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Sigma releases financial results

Staff Writer

Thursday afternoon, 31st March 2010.

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Thalidomide treats hereditary blood disorder

Staff Writer

Thalidomide, the sedative blamed for tragic birth defects, treated a rare inherited blood disorder, according to recent experiment reports.
Around one person in 10,000 has a disorder called hereditary haemorrhagic telangiectasia, or HHT, which causes frequent, hard-to-treat nosebleeds.

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Climate change to shed light on dengue fever

Staff Writer

Queensland University of Technology (QUT) research into the impact of climate change on dengue fever may lead to better control of the mosquito-borne disease.
Researchers from QUT's School of Public Health are examining the relationship between climate change and the incidence of dengue in the northern Queensland city of Townsville and the capital of Bangladesh, Dhaka, combined with their rapid socio-environmental changes.

Comments: 1

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Lachlan Rose - New Face on NSW Branch Committee of PSA

Staff Writer

Manly Vale pharmacist Lachlan Rose has been appointed to the NSW Branch Committee of the Pharmaceutical Society of Australia to replace Alison Roberts who has resigned to move interstate.
Lachlan is a community pharmacist at Manly Vale on the North Shore of Sydney and is a current member of the NSW Early Career Pharmacist Working Group, having previously held the position of President of the NSW Young Pharmacists Committee of the PSA.
While holding this position Lachlan contributed articles on student activities and opinion in i2P.

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iPhone application to scan for food allergens

Staff Writer

Allergy sufferers could soon be able to use their iPhone to scan a food’s barcode at the supermarket to determine whether it’s safe to eat.
The application being developed by Deakin University, GS1 Australia and Nestlé, will allow consumers to instantly access detailed product information including allergens such as wheat, egg, peanuts and shellfish directly from their iPhone.

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Sigma Battles On

Staff Writer

Sigma is not yet out of danger and control is vested in its bankers.
Shareholders will be excluded from dividends in favour of debt reduction and the banks will be monitoring management decisions for some time to come.

This certainly reduces management flexibility but fortunately for Sigma its banks waived the breaches of covenants and renegotiated their facilities with re-set covenants, presumably agreeing with Sigma that its underlying results – a profit of $67.7 million was sound. Sigma doesn’t face principal repayments until early next year.
An unusual aspect of the overall result was that while underlying earnings were down 15.5 per cent, sales were up 4.5 per cent.
That can be attributable to the increased competition and discounting towards the end of the year to January that triggered the review of intangibles but Sigma also referred to some self-inflicted damage.

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Dementia Day Care Should Help

Staff Writer

Dementia is a major health issue in Australia and is increasing in line with the ageing population.
One of the better government initiatives has been to plan and set up a range of Dementia Day Care Centres, the first of which has opened in Orange, NSW.
Given that over a lifetime we seemingly start and end in a similar state (i.e.childlike) it seems natural to find solutions for dementia patients in paralleling early childhood solutions.
We have Day Care for children now well established.
Day Care for adults will relieve the pressure for many carers and family members who act as carers.

NEW DEMENTIA DAY CARE CENTRE IN NSW

Source: Australian Ageing Agenda

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RACGP Launches e.Health Futures

Staff Writer

Electronic health communications have had many obstacles to overcome, but we now appear to be on the home stretch.
Fumbling by government has been the main problem, because they did not seem to know what they wanted, leaving many private enterprise vendors trying to guess their way into the future.
This has proven very costly and extremely inefficient.
Even when the government formed NEHTA to plan and smooth the way, the right people did not seem to be at the helm.
Now NEHTA is talking to a range of major players and the e.health agenda is suddenly coalescing as it should have done, some years back.

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Sigma still in turmoil

Staff Writer

Sigma continues to struggle to maintain its viability and obviously needs a “white knight” to come to its rescue with an offer of a friendly merger or takeover.
It is believed that some interest has developed for a transaction of this type, but may be less likely with most of the principal architects of the company's decline still in place
With the recent resignation of Mr Elmo de Alwis, attention is now turning to John Stocker (chairman) and Mark Smith (chief financial officer).

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Poor Document Assembly Processes Cause Problems

Staff Writer

The US is well advanced in the delivery of electronic health summaries and their promised benefits.
However, protocols are being found deficient to preserve the integrity of the documents.
Short cuts in the assembly of a document involving a "cut and paste" from other documents are introducing inaccuracies damaging to the content as a whole.
The danger in "cut and paste" is that an error can be perpetuated and multiplied many times with the potential to cause major harm.
It would seem that a discipline has to be exerted through proper training, particularly by new users.

Australia has the ability to put the training steps in place in advance, to eliminate this potentially serious problem.

Doc calls EHR copy and paste function a "modern medical illness"
Source: Healthcare IT News

http://www.healthcareitnews.com/news/doc-calls-ehr-copy-and-paste-function-modern-medical-illness

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Wanneroo GP Super Clinic gets go ahead

Staff Writer

A funding agreement between the Australian Government and Edith Cowan University will see the $10 million GP Super Clinic established in Wanneroo.
Edith Cowan University will now work with the City of Wanneroo and the North Metro Area Health Service to begin designs and develop business arrangements and clinical services.
The Wanneroo GP Super Clinic, which is being jointly funded by the Western Australian Government, will deliver additional health services to the area to take pressure off the Joondalup Health Campus, and ensure local families can get the health care they need.

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RACGP response to CoAG agreement on health reform

Staff Writer

The Council of Australian Governments Meeting (CoAG), with the exception of Western Australia, agreed to establish a National Health and Hospital Network at this week’s CoAG meeting. The National Health and Hospital Reform Commission has recommended the development of a person centred, strong, equitable, integrated primary health care system and the college is pleased that CoAG has taken this challenge up. The CoAG communiqué is available at www.coag.gov.au.

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Suddenly the PGA discovers "Pharmacists"

Neil Johnston

A media release published this week indicates that there will be an oversupply of pharmacists of around 2009 in surplus within five years.
The release was based on a recent survey of which the author details appear in the news report below.
The last survey into the Pharmacy Workforce circa 2003 indicated there would be a shortage of pharmacists.
i2P reported on that survey and commented:
” The long awaited workforce report from the Third Agreement has arrived and the news is gloomy for those wanting an early retirement or thinking about cutting their hours back. By 2010 we'll be 3000 pharmacists short of meeting demand and as far as ever from filling the gaps.
I strongly recommend any pharmacists who intend to be practicing anytime in the next 10 years read though this report (A Study of the Demand and Supply of Pharmacists, 2000 - 2010). “
Goto link:
http://www.computachem.com.au/i2P/emag/Issue13/Article8.shtml
Well, we are progressing into 2010 and the projected shortfall of pharmacists did not happen.
Why then should we believe the current projection?
To develop some thoughts on this issue we have asked Mark Coleman to comment on the Pharmacy  News report published on the 24th March 2010 which follows:

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The Great Debate - an informed comment

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.

Following on from the Rudd/Abbott debate on health reforms a great deal of expected commentary resulted.
One of the better versions was published in theage.com.au and is found at this link:
http://www.theage.com.au/opinion/society-and-culture/health-system-is-more-than-just-hospitals-20100324-qwmg.html#comments
The article was written by Trevor Carr, who is chief executive of the Victorian Healthcare Association, that represents public hospitals, rural and regional health services, community health services and aged-care facilities in Victoria.
He states:
"The focus on beds and waiting lists ignores the role of primary care.Reform should move the health system from its current simplistic emphasis on hospitals and waiting lists to a system of interlinking elements that include acute care, primary care, early intervention, health promotion and illness prevention."

That statement is so sensible it is hard to think in any other terms. When Nicola Roxon first took up her position as Minister for Health and Ageing she came out in strong support of prevention, which meant a large slab of primary health care that pharmacy expected to be part of.
Her first foray was to establish GP super clinics.
They have been progressively introduced, but establishment costs seem to be a problem.
Also, the role of pharmacy within these clinics has never been properly negotiated or thought through.

open this article full screen

"The debate between Kevin Rudd and Tony Abbott has failed to deliver any suggestion of health system reform. Instead, it concentrated on credentials for economic management and trust, and as a result has simply reinforced the status quo model of health service, albeit under different administrative arrangements."

If this is truly the intent of the current government then we are going to witness a health disaster.
The current system is intolerable to those who have to make it work, and positive changes must occur.
The last successful model for a public hospital system in NSW was the local board version with a mix of requisite skills involving maximum support from the local community.
This worked and I can recall always paying into the highest table in the hospital fund because it was affordable!

"All we know of the opposition's health policy is that it will devolve governance responsibility to boards in NSW and Queensland. While not expecting a complete policy, it may have helped the Opposition Leader to, at the very least, identify the key alternative principles of reform the conservatives would apply if in government."

More detail here would have definitely gained more "brownie points".

"In releasing his health policy in pieces, the Prime Minister lends support to a view that hospitals, primary care and prevention are separate functions within the health system. They are, in fact, functions that must successfully meld as one to create the health system. Rudd refers to integrated health system reform but does not clearly articulate how his proposed changes will achieve this."

As currently structured, hospitals, prevention and primary care exist as separate functions.
The gears do not mesh and they must become integrated.
All the players in health clearly see that perspective - why not government?

"His reform agenda splits responsibility for the healthcare system between funding (Commonwealth) and distribution (states). The Commonwealth government's decision to take on 60 per cent of the efficient price of hospital care is not reform, nor will it end the blame game.
To end the blame game, the Commonwealth must assume 100 per cent funding responsibility. A total takeover would enable new approaches to service delivery that could reduce demand for hospital bed-based services."

A complete takeover of the public hospital system was a core election promise by Rudd.
If this is not addressed, Rudd will lose votes at the next election as the opposition list all of the shortcomings of Labour's policies and performance deficiencies.

This requires a funding model that creates and encourages choice in clinically safe service options - be they bed-based, ambulatory care centres, or home treatment.

A "pharmacy in the home" service is looming as a very real option for pharmacy in its race to stay relevant, viable and visible.

A community pharmacy delivering this service on a broad front will not need a prime retail position to
operate. Pharmacies wishing to provide a range of professional services will be able to do so in lower rent locations and direct the funds saved in this major expense towards the employment of extra pharmacists, by contract or in-house.

"If Australia can reduce hospital demand by 5 per cent, it will free up $1.6 billion nationally to develop primary care options. Unfortunately, activity-based funding will not achieve this goal, as it merely reinforces a service model that requires admission and discharge from a hospital bed - a high-cost option."

Every effort needs to be made to prevent hospital admissions from occurring unnecessarily.
"Pharmacy in the Home" programs would go a long way to meeting this objective.
Further, "Hospital in the Home" programs that have been properly established and introduced also go a long way to meeting this objective.
Originally the federal government provided seed funds to introduce this service provided the area health service picked up ongoing funding after the seed funds ran out.
Even when careful monitoring disclosed major savings, the majority of health services simply left the program starved, so they progressively closed down.
I personally spent countless hours determining stability of antibiotics in pre-filled delivery devices (pumps, syringes etc) to successfully keep people out of hospital beds and even going to work with pumps attached discretely.
This is an activity that both hospital and community pharmacists can develop in partnership.

"With 75 per cent of hospital costs consumed by wages, there is little doubt that reducing industrial demarcation issues that stymie the most productive use of scarce health professionals represents the greatest potential to efficiency.
Industrial relations remains a state responsibility under the Prime Minister's reform agenda. In proposing a funding model based on the efficient price, the Commonwealth government must ensure industrial reform that enables efficiency."

The simple fact is that hospital employees have been stretched for so long "doing more with less" they are simply exhausted. Motivation has been destroyed and people struggle to balance their professional obligations against the resources provided.
Workplace bullying has also increased as managers introduce fear as a means of covering their own backsides, and to get things done.
This process never works - it just destroys productive workplaces.

"That efficient infrastructure is essential to efficient pricing was confirmed in work commissioned last year by the Victorian Healthcare Association from Access Economics. In Victoria alone, an estimated $10 billion will be required for the next decade to ensure the infrastructure needed to service the Victorian health system is of a contemporary standard, and provides equal opportunities for health services to work to an efficient price.
There is no indication that anywhere near this level of investment is being contemplated by either side of politics at the national level."

And so we arrive at the real reason for Rudd not taking over the hospital system.
He lacks the political will because he knows there are insufficient funds-now or later.

"It is disingenuous of the Prime Minister to suggest that system improvement can only be achieved by directly funding local hospital networks. Victoria - the ''efficient'' state - currently receives the funds from the Commonwealth and redistributes them through an activity-based formula to hospitals that are independently governed by boards.An alternative is for the Prime Minister to seek nationally agreed minimum standards for service access and service quality as a prerequisite for the transfer of funds from the Commonwealth to the states. The proposed local hospital network model could represent the minimum standard in such an arrangement, therefore allowing the continuation of a higher standard, as represented by the Victorian model.
To fund its reform, the Commonwealth wants to retrieve from the states a third of their GST allocations. For the Northern Territory, this equates to $900 million when combined with its health special-purpose payment, at a time when its acute health budget is under $600 million. It is imperative that the Commonwealth's fiscal assessment be transparently debated, as the current proposal adds up for very few states."

Rudd should listen more closely to those people already delivering primary healthcare - right to the coalface. Listen and then work backwards to the middle ground of infrastructure building from the bottom up.
Once in the middle ground a fusion with the "top" will make more sense, because the current "top down" delivery mechanism will never work - the distance separating top from bottom is too great.
It is a high cost process.

"Unfortunately, the health complications associated with ageing have become an inconvenient truth to policymakers working within election cycles. More money is needed to ''fix'' the problem. More investment is needed in primary care options. More leadership is needed in changing the key performance indicators of system effectiveness away from waiting list data to a focus on reducing bed demand through primary care initiatives."

The anti-ageing and aged care markets represent the biggest opportunity pharmacy will ever see.
Unfortunately, the division between professional service pharmacists and pharmacies currently prevents this from occurring.

It is time the PGA abandons its power plays.While it may satisfy some egos, most of the profession simply wants to lift its game and flesh out the core business of primary care, particularly in the areas of preventive medicine, aged care and anti-ageing services.

A whole of profession approach where the pharmacy provides infrastructure and the pharmacist provides professional service will help to restore an appropriate balance.

 

 

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