s Part one -HMR Evolution | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


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

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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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Part one -HMR Evolution

Neil Johnston

articles by this author...

Neil Johnston is a pharmacist who trained as a management consultant. He was the first consultant to service the pharmacy profession and commenced practice as a full time consultant in 1972, specialising in community pharmacy management, pharmacy systems, preventive medicine and the marketing of professional services. He has owned, or part-owned a total of six pharmacies during his career, and for a decade spent time both as a clinical pharmacist and Chief Pharmacist in the public hospital system. He has been editor of i2P since 2000.

With the furore created when the PGA went to print stating that the funds available for HMR’s were almost exhausted, it created an instant “blame game” and conjecture as to what really lay behind the belated PGA announcement.
I came to a conclusion early that it was a result of PGA mismanagement as the immediate problem, but also coupled with an underlying systemic flaw that was the major problem.
Between them they impact and threaten the long term development and survival of the consultant pharmacist program.
It has prompted me to create an analysis of some aspects of the program to evaluate what has gone wrong.

Where to start?
At the beginning, of course, circa 1977, when future pharmacy design (by the PGA) was envisaging three forms of pharmacy development – the supermarket variety, the clinical variety and the existing corner store version.

Because of my background as an accredited management consultant to CMC (international level), I was very early able to see the vision of pharmacists performing in consultant roles.
Few pharmacists have experienced this form of training let alone work as a true consultant in the cold and hard environment of business at large.
This was around 1978, and as was my habit, I began to flesh out a business plan to document and test the concept of a consultant pharmacist (as distinct from being a pharmacy consultant).
When it came to the point of service design, I came to the conclusion that apart from medication reviews, nutritional consultancies would have public benefit, even though the science surrounding some of the nutritional supplements was a bit sparse.
An Integrated Medicine concept also seemed to have patient interest and support as the service outline was detailed to a small range of patients.

Statements by the government of the day also supported the notion that pharmacists ought to be gatekeepers for nutritional supplements, by virtue of their training, and were deemed the best health care professionals to deliver information and assistance to patients and other consumers.
It was also thought that nutritional supplements would be a good fit into a preventive medicine segment of Primary Health Care.

And the PGA seemed to be on the same page because they later created the College Of Advanced Clinical Nutrition that attracted initially over 500+ pharmacists to enrol and qualify with an Advanced Diplomas of Clinical Nutrition.

I had joined in full support and on graduation night I met for the first time the president of the Queensland Pharmacy Guild…Kos Sclavos.
I talked to him after the presentation ceremony and expounded on my views for clinical nutrition as a wing for consultant pharmacists (not yet evolved at that date) – in fact that a diploma in clinical nutrition ought to qualify a pharmacist for full membership in any consultant organisation.
Up to this point in time, the creation of consultant pharmacists had received little attention or debate. But it was just starting to be considered as a unique opportunity for pharmacists.
Kos advised that discussion had just started within the PGA on the design of consultant pharmacy, so I went on to expound on the possibility of consultant pharmacists forming up in their own business and contracting independently with a community pharmacy to formalise a place of practice.
I further commented that with the future of pharmacies heading towards supermarket style pharmacies, losses in PGA membership could be augmented by offering membership to consultant practices, because it was thought that pharmacy membership would deplete as amalgamations and takeovers occurred with community pharmacies.
It seemed to me a “win-win” situation, and Kos said he would discuss the matter internally and get back to me.

Well that never happened – at least as far as the getting back to me was concerned – but I am absolutely certain that the matter was discussed internally.

There was a lot of enthusiasm and goodwill surrounding the PGA College of Clinical Nutrition and there was general agreement that the college initiative was a great success judged by all participants.

Then a series of events that seemed to be orchestrated by the PGA occurred:

(i) The College of Clinical Nutrition was closed, ostensibly because the head of the college was poached by the AMA, for their own version of a nutritional college for doctors.
But no attempt was made to recruit a new head for the pharmacy college.
All infrastructure was in place, course material had been developed, it was popular and successful.
No explanation was ever given for this waste of a valuable resource.

(ii) The clinical pharmacy model was seemingly dropped by PGA with no further mention made of this fact or an explanation given. This has been commented upon in pharmacy media from time to time and it still remains a mystery.

(iii) The Australian Association of Consultant Pharmacy was formed – not with competent pharmacists as member shareholders, but only the PGA and PSA as shareholders.
The philosophy is further hinted at in that the organisation name refers to "pharmacy" - not "pharmacists".
This meant a tight lid was kept on consultant pharmacist development and direction.
I am in no doubt as to the reasons, but it has led to the current mismanagement of HMR’s.
There is no real input by consultant pharmacists because they are excluded from policy and funding decisions.

A proper consultant association (such as the Institute of Management consultants http://www.imc.org.au/html/s01_home/home.asp  ) runs their organisation to support consultants at all level of development.
Their training insists that consultants, when accepting assignments, accurately identify what is called the “control executive” – the person with whom you have to receive your assignment from and who eventually pays you.
In a pharmacy context, this should be the patient.
Imagine my horror when the first model involved GP’s referring to pharmacies and then on to generally tied consultants to that pharmacy.
The competing interests grafted between the patient and the consultant should have made any valid professional consulting association shudder with horror.
I guess it’s only the government funding that has held it together and the one successful product that has emerged – HMR’s-while being a good one, is set to be strangled because the PGA has not had processes in place to halt any abuses or manage the entire program efficiently
Simple management procedures introduced with ongoing reviews is the norm for any organisation. Regular feedback ensures that trends noting people who are rorting the system can be quickly brought back into line.
For the PGA to call for a moratorium on all HMR production is not only disruptive to consultants, but is ridiculous in the extreme.
Their real motive needs to be questioned.
What if a moratorium was called on dispensing for just a single month?
How many patients would be damaged by that process?
How many pharmacies would virtually disappear when separated from their cash flows?

A professional services stream is the only bright spot for newly graduated pharmacists and HMR’s are probably one of the few valid services provided by pharmacists that genuinely supports patients and provides care.
For the PGA to be involved in any form of HMR management is a conflict of interest when it is known that that other “quickie” forms of medication reviews are being proposed and at the moment look as though they may be be funded from HMR funds.
The weak and belated explanations being released by Kos Sclavos on behalf of the PGA are simply a monument to bad management.

On the 12th March 2012 Kos Sclavos reported in Pharmacy News media that 5CPA spending was on track.
Have a look at :

"Spending on the Fifth Community Pharmacy Agreement (5CPA) is at record levels, Kos Sclavos, Pharmacy Guild of Australia national president, revealed at APP 2012 last week.
Speaking at the State of the Industry symposium, Mr Sclavos said spending on 5CPA programs was on track after the first year of the agreement.

“I’m very proud that in the first year of the agreement, 99.3 per cent of spending has occurred,” he said.
“That is the first time in the history of any CPA that that level of output and productivity has occurred.”

Mr Sclavos said community pharmacists should not underestimate the importance of the achievement.

“In the last agreement we underspent by $100 million,” he said.

“It’s use it or lose it, and in the last agreement we lost it.”

Surely that must include HMR Funds and isn’t he telling us all that everything is o.k?
And he talks about productivity then but now puts excess expenditure down to “rorting” by a small segment of the HMR community.
They have had productivity gains as well surely?
They have definitely used it – but they still may lose it, along with all the other casualties.

It would seem that simple rules built around the quality of an HMR need to be introduced as a first step.
Rules such as scoring an HMR as to whether the interviewer and the report compiled were done by the same person; whether the review was conducted in a patient’s home or other location.
If a pharmacy receives an HMR referral and elects to send out a non-accredited pharmacist to do the interview, (the most important step in an HMR), quality will suffer if that HMR then passes to a reviewer to analyse the interview and compare it to referral information.
It’s simply inefficient and a lower quality performance, and should be scored downwards for reimbursement.

A simple tick box identifying the above criteria plus a claimant’s signature should suffice to determine basic quality and price-and that should slow down any rorting of the scheme.

The current HMR alarm (it's not a crisis) is a break in the fabric of the political and managerial structure surrounding the governing organisations.
It is a flawed model and illustrations as to why are demonstrated in parts two and three of my analysis.
Tanya Pliberseck has now ridden to the rescue and assured consultant pharmacists that all will be well and a new consultant pharmacist management group has sprung up to fill the apparent breach, promoted by academics at the University of Tasmania.
I hope it stays and competes actively with the PGA/PSA existing version

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