s Independent Pharmacist Practitioners | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2009         Volume. 1 No. 2   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July edition of i2P, and of course, the first week of the new financial year.

Note that we are developing a new range of categories for you to follow e.g. health politics, hospital news, an expanded IT offer and we will be developing the category of anti-ageing medicine

Also, out of interest, could I refer you to the e-publications category located immediately below our columnists. If you click on the link contained there, you will find a range of e-publications that are recommended reading.

The first publication noted is the Pharmacist Activist written by Dr Daniel A. Hussar of the faculty of the Philadelphia College of Pharmacy at the University of the Sciences in Philadelphia. He is a pharmacy advocate.

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Recent Comments

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I’ve seen the future…….and I’m not happy, Jan!

Chris Wright

The ubiquitous Mrs Wright, in her quest to unearth a new erotic shopping experience, ushered this writer to a new Coles store located at the all very nice and leafy suburb of Ivanhoe in Melbourne recently.
This is contemporary retailing at its best, no doubt influenced by the gurus at Westfarmers and the rapidly changing retail climate in Australia, which of course involves the future of Pharmacy in some way….but more about Pharmacy later.

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Pharmacists losing their mojo

Neil Retallick

I read some market research recently that ought to concern community pharmacists across the country, as well as the Pharmacy Guild of Australia.
Groups of average Australians were brought together for a series of focus groups to discuss the community pharmacy landscape as they see it.
Some of the feedback was disconcerting.

Comments: 3

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Has the horse bolted?

Ken Stafford

Some twenty years ago uneasy tremors were running through hospital pharmacy here in Perth. Hospital management had suggested to one of my fellow Chief Pharmacists that the hospital needed a total parenteral and intravenous additive service (IVAS) .
When it was pointed out that this would be very labour intensive and the pharmacy did not have sufficient staff to provide it, the comment was that “nurses would be happy to run such a service”.

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Independent Pharmacist Practitioners

James Ellerson

In the region where I practice, GP’s are reluctant to comply with a patient request for a Home Medication Review.
The stock standard phrase is “I can do that for you” and so in frustration a patient will turn to me, in a professional, or quite commonly in a social setting, and asks if it is possible for me to perform a review without the doctor’s involvement.

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Disgraceful – discuss

Pat Gallagher

Disgraceful – discuss
The newspapers have been chock-a-block the past few days with dire tales but true about the black hole we are about to enter with the insane policy to re-regulate the ‘workplace’ to suit the union paymaster cliques.
While I never voted for Keating I did admire him a little bit this morning when I read a quote of his from the bad old days.
He said to some union goose: “you are carrying the jobs of (100,000) dead men around your shoulders”.
Giving a dead hand to this union unfettered power play will ensure that the nation will soon look like NSW; where the government is actually the plaything of a few loosely combined public ‘service’ union mugs.
Depending on how large your pharmacy is, in terms of overall staffing, you will soon be touched by the coming dead hand of the new/old order.

Comments: 3

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UK Dispensing Errors Under Review

Staff Writer

The recent furore in the UK over pharmacist Elizabeth Lee receiving a conviction for a criminal offence and subsequently a suspended jail sentence, has really lit a fire under the imbalances that exist when a pharmacy dispensing error is made.
The dispensing pharmacist or the supervising pharmacist under current UK legislation, has been made to bear the brunt of legal responsibility, with pharmacy owners escaping with little pain.
According to an article in PJ Online "In many cases, all that the employer needs to establish is that he had standard operating procedures in place and that the employee or locum had simply not complied with them. In these cases, the employer can walk away leaving the employee or locum to face the, often damaging, consequences".
There is now a rush in the UK to have current legislation amended to reflect a more proportionate responsibility for all parties involved.

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A New Ministery - Indigenous, Rural and Regional Health

Staff Writer

The appointment for the first time of a Minister for Indigenous, Rural and Regional Health and Regional Service Delivery is an important strategic recognition of the special needs and circumstances facing people in Australia's rural and remote communities.
People in the bush will expect this position to be part of a permanent increase in the Government's commitment to rural communities.
In welcoming Minister Warren Snowdon to the new position, Dr Jenny May, Chairperson of the National Rural Health Alliance (NRHA), said the appointment will be important both for substantive policy reasons and to boost the place of rural issues on the political agenda.

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NZ fish killed by water quality

Staff Writer

The following news item was recently published in Science Alert. It would seem that the pristine environment of New Zealand is under attack. The reasons are similar to those findings in Australia surrounding the protection of the Great Barrier Reef.

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New theory for global diabetes epidemic

Staff Writer

A new "fertility first" hypothesis published this week by a group of international experts in the American Journal of Human Biology, proposes that the global epidemic of Type 2 diabetes has its origins in the struggle, over millennia, to sustain human fertility in environments defined by famine.
A surprising and important implication for us in the modern world is that this hypothesis gives cause for optimism that the modern epidemics of diabetes and cardiovascular disease will diminish.
Source: Sydney University

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Immune system key discovered

Staff Writer

A team of Monash University researchers has discovered the importance of a protein, which could improve the way the drug interferon is used to strengthen the human immune system.
Published online in the prestigious journal Immunity, the findings show that the protein promyelocytic leukemia zinc finger (PLZF) is a key player in the body's immune response to disease, increasing our understanding of the function of the immune system.(Source: Science Alert )

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Political suspicions raised as China cracks down on bogus online health info

Staff Writer

China is notable for its authoritarian approach to the Internet and other forms of media communications.
Restrictions on Internet activity may have some long-term implications for Australia, particularly as these restrictions are intruding into the health arena.
Source: Tech.Blorge

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Senior Pharmacists - A Valuable Resource

Staff Writer

Little thought seems to have occurred in maintaining and supporting mature aged pharmacists in the workplace.
Given that this group of pharmacists is the one with the "corporate memory" of the profession, with many having started life as compounding pharmacists and counter-prescribers, there is a wealth of untapped intellectual resource that could be internally utilised in mentoring or even training pharmacists in how to sell a professional service.
This group of pharmacists is concerned with the development of retail clinics proposing to do almost exactly what they were successfully doing 30-40 years ago.
What went wrong?

Well, there is plenty of evidence to illustrate that the process of commoditising medicines is the primary reason for this loss, because if you strip everything out of a process to sell at the cheapest possible price, you get a barren professional offering
Source: Science Alert

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Terry White Makes a Move

Staff Writer

Introduction:

It is clear that the Terry White pharmacy group is on the move with the recent purchase of Pharmacy Direct and a restructure of its own management. Terry has had a distinguished pharmacy career and his stewardship will see possibly the strongest pharmacy group in Australia emerge He is opening up the opportunity for equity for senior members of his management team.
The following excerpt extracted from pharmacy media reports explains the process.

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Independent Pharmacist Practitioners

James Ellerson

articles by this author...

James Ellerson is passionate about developing primary health care services across the spectrum of all health care practitioners working in a practical alliance, whether in an urbanised or a remote setting.
He sees a wide range of opportunities for all health professionals who are currently held back by lethargic leadership.
Attitudinal change is now under way because of new directions being set by governments both globally and in Australasia, creating empowerment of patients, better systems of delivery, with all resulting in primary health care at an optimum level.

In the region where I practice, GP’s are reluctant to comply with a patient request for a Home Medication Review.
The stock standard phrase is “I can do that for you” and so in frustration a patient will turn to me, in a professional, or quite commonly in a social setting, and asks if it is possible for me to perform a review without the doctor’s involvement.

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I am very reluctant to be involved, because a full review may not be possible if the patient is unable to provide test results, plus a full list of diagnosed conditions and a list of drugs taken prior to the current drug regimen.

All this with the known fact that the GP involved will not accept the results.

The danger, in these instances, is that high levels of professional friction may be generated.

But on the occasion when I can see a patient may benefit, and a reasonable level of information is available, I give in, if only to equip the patient with information to debate with their doctor.

There is no payment involved but there is often an insistence that my time should be reimbursed. On those occasions I nominate a “good cause” and suggest a donation be made to whatever level the patient feels comfortable with.

Mostly patients are simply looking for good information in respect of potential drug/drug interactions, and whether some of the effects they may be feeling can be attributed to the drugs they are consuming.

Also, whether there are any alternatives that can help in their conditions that they may be able to utilise to their benefit.

It is a pathway that can backfire because it will not necessarily win the doctor over to the patient’s cause.

Another direction is to suggest a patient find a more cooperative doctor and request a formal HMR referral.

On the other hand, a pharmacist is eminently suited to providing the abbreviated service illustrated (provided it is evidence-based) and if benefit is acknowledged by the patient, there is no shame in accepting a fee for this service.

We are told that we should be educating patients so that they are able to take responsibility for their conditions and treatment, and many wish to do this.

Many patients will simply enter into the process, looking over their shoulder in fear that their doctor may take exception.

When we talk about the development of professional services there is such a gauntlet to run from the medical profession, who aggressively defend their “turf” on any and every occasion.

Pharmacists are universally acknowledged as being under utilised, highly trained health professionals, capable of making a difference in the areas of self care and primary health care, and could do so if the thought of reprisal did not exist.

Therefore, this issue has to be faced head on by individual pharmacists willing to pioneer a professional service that is not dependant on reimbursement from the always pressured Pharmaceutical Benefits Scheme (PBS).

The few that are prepared to pioneer and undertake the fight will have to face the dramas in many instances, without official pharmacy support, for that is the case for the moment.

The Green Paper currently being prepared by the Pharmaceutical Society of Australia may give some insights and direction, so that when a White Paper finally emerges, there may be some support for professional services that can be progressively implemented.

The pioneers will initially have to find their market among the more affluent group of patients, but this market is a fairly extensive one, represented by retiring “baby boomers”, who have the wish to remain healthy and are proactive about it.

Once services are established and the government can see benefit, there may be a willingness for them to subsidise a service for those patients not able to pay on a private basis. But the service will have to be established ahead of any government subsidy, so independent pharmacist practitioners will have to put their capital at risk (like any other business) and fund their own initial research into what would form up into a viable professional practice.

I would never enter into a subsidised agreement with a government agency that dictated the price charged to a consumer. The lesson has been learnt through the evolution of the PBS system, and the reimbursement problems inherent in that system need to be avoided at all costs.

Pharmacist practitioners would also need political representation, and that will not be forthcoming through the PGA. The PSA remains a question mark for the moment.

The time is right, however, for like-minded pharmacists to form themselves into a political group and begin to define their future.

Independent practices can provide services from a pharmacy environment, from a GP super clinic environment, in a hospital or nursing home environment or within their own private environment.

Getting a group of pharmacists willing to undertake this direction, and I believe, preserve the core values of the pharmacy profession, will stimulate a positive and creative process giving pharmacists a hope for their future.

I actually know of one pharmacist who owns a non PBS pharmacy surviving on compounded and private prescriptions. On each afternoon, he conducts a consultative practice around his specialty, which involves supplementation of hormones of various types.

His evidence-based practice supports the notion that many lifestyle illnesses are indeed cause by hormone imbalances and insufficiencies.

Patients have to book up to six weeks in advance to have a consultation, and business is booming.

But he comes under fire from the medical profession no matter how ethically he runs his practice.

The weak link is when his patients are referred to a GP having had prior tests performed by an accredited laboratory, local GP’s will not accept the results, forcing patients to undergo a second set of tests through another pathology group.

To add insult to injury, many of these GP’s simply do not understand the principles of hormone supplementation and should not have accepted the referral in the first place.

He is also accused of exploiting patients because his charges for pathology etc are not subsidised by Medicare. Doctors point out the price difference to the patient but never disclose that government subsidies are involved for their service.

This type of GP is highly unethical, and there are quite a number in any location.

If a pharmacist was to carry on a similar activity against any GP practice there would be immediate and aggressive complaints by GP’s and cries of being unethical hurled at the pharmacist involved.

Because this particular pharmacist is transparent, and is providing a genuine benefit to his patients, there is a genuine patient-pharmacist relationship built, with a loyal and ever-growing patient base as a result.

It can be done.

 

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