s The Great Debate - an informed comment | 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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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

Comments: 1

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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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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.

"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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