s Pharma-Goss - Change needed in Pharmacist Role in PBS Supply | 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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Pharma-Goss - Change needed in Pharmacist Role in PBS Supply

Rollo Manning

articles by this author...

Rollo Manning has experienced pharmacy practice from all sectors of the industry – retail, administrative, policy and remote Aboriginal practice. He spent 10 years with Glaxo Australia and was the first Director of Public Relations at the Pharmacy Guild National Secretariat in Canberra.
He has also held the position of Pharmacy Policy Officer for Territory Health Services in Darwin.
Rollo is currently a Consultant working in his own practice with remote Aboriginal communities, in Northern Australia.

The weekly publication MJA Insight carried an article on 23rd July edition suggesting that pharmacists should be utilised to carry out well person screening to identify persons that could be at risk of developing chronic diseases.
Find it at:
http://www.mjainsight.com.au/view?post=garry-jennings-let%25e2%2580%2599s-test-pharmacy-screening&post_id=10020&cat=comment

The author, Dr Garry Jennings suggested a trial to ascertain acceptability of the idea.

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This column believes any such “trial” should only be conducted as a part of an overall restructuring of the way “Approved Suppliers” fit in with supplying Pharmaceutical Benefits Scheme medicines.

It would be the opportunity to leverage a change in the way pharmacies are utilized by government to deliver health services through the establishment of a PharmaCare Agency that is accredited to provide such services and receives a fee for doing it. Like medical practice the base fee would be the minimum remuneration.

And yes they could dispense PBS medicines too.

The present process of granting an Approval Number to EVERY pharmacy that was in business in 1990 with no follow up on efficiency, effectiveness or intent to improve health outcomes has made a mockery of the "approval" process.

For mine ALL pharmacies should have to reapply for an "Approval" that would require them to provide a certain range of services for which they would be paid an amount determined by an INDEPENDENT agency (e.g PharmaCare). The holder of the approved Agency would be required to have studied an additional range of subjects and have obtained some post graduate qualification in order to safely carry out the new responsibilities that are on offer with a PharmaCare Approval.

The days of dispensing PBS as a right must go and responsibility to carry out health promoting functions put in its place.

It might also be the opportunity to consider alternative outlets to be PharmaCare Agencies and break the pharmacist owned monopoly on a pharmacy business. There is no reason why multi purpose health centers, primary health care facilities, GP Super Clinics or Aboriginal health services and other retailers such as supermarkets should not be allowed to bid for a PharmaCare Agency if they meet the criteria.

In this way pharmacists could be fully utilized as a significant contributor to primary health care and not just the ones who put labels on boxes.

The improved income from such a positive change may mean there is not the same incentive to maximize turnover by stocking sham products with no evidence base.

The present news item about New Zealand restructuring its remuneration arrangements are worth examining and it is certainly known that pharmacists in Australia would welcome a shift in emphasis to a more clinical role. It may not suit the hard nosed profit makers but that is too bad - health of the consumer should always come before pharmacists' wealth.

It is over 25 years since there was an assessment of the retail pharmacy industry and surely it is timely for something to happen now. It is cruel that consumers are asked to pay $11 in fees for the dispensing of a product that costs $3 – as is the case in a commonly prescribed beta blocker. This would be the time to bring in a fee for service and rid the system of all the individual components of the overall fee with no one really knowing what they are paying for and why.

The day must come when pharmacists are seen as true professionals in primary health care and not money grabbing entrepreneurs on the fringes adding to the vested interests that want to maintain the status quo in health service delivery.

This column has been advocating for a differential fee with more paid for work done in counselling compared to work done for dispensing repeats.

I believe there should be a total restructure of the PBS dispensing contracts so that Approved Pharmacy Suppliers have to commit to a range of functions for which they are fairly remunerated an amount determined by an independent agency such as PharmaCare (like Medicare).

Comments welcome to Rollo Manning, PO Box 98 Parap NT or rollom@iinet.net.au or 0411 049 872

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Submitted by Stuart on Tue, 31/07/2012 - 20:58.

This 'pharma-care' idea is nonsense!

Community pharmacies already deliver the service of which you speak. Moreover, they are delivering more and more services and healthcare awareness but the limiting factor is the community's and govt's reluctance to pay.

A lot of services are already provided FREE using the fat provided by the dispensing fee and markup. I for one provide hours of counseling, advice both about products, services and helping patients negotiate tedious govt schemes for which I'm not remunerated. Not to mention the hours of work involved in webster packing, dosette dispensing, deliveries, chasing up scripts from recalcitrant doctors for elderly folk unable to look after themselves, that is extremely poorly remunerated.

Do you think $5 per week covers the average 30-40 minutes per customer it takes to pack up their pills + the cost of the packing materials + staff costs + delivery costs?? What about when they get discharged from hospital and all their packs need to be altered? Does the $5 cover the liasing with the GP, patient, hospital to pack up the new pack and have it ready for the patient within a couple of hours?? What about the changes that the GP then initiates when the patient goes back to the GP after discharge??

NO!! the true cost of this in my time and effort would probably be $200.

The govt should be thankful that community pharmacies perform the tasks that they do, keeping these elderly folk at home as long as possible saving the govt millions in nursing home costs and medication misadventures. This is why the current system of remuneration should be kept and fees given IN ADDITION for services delivered.

Levels of remuneration need to be kept high for pharmacists to attract high quality candidates otherwise they will all choose other careers, such as medicine where you can easily earn $200,000/pa for a 3 day working week. I have spoken to uni staff in the UK that lament the low quality of current students. As there is low possibility of ownership due to the entry of the supermarkets into the sector, there is little financial incentive to study pharmacy so high calibre students go elsewhere.

Current ownership restrictions should remain as supermarkets have nothing to offer. My experience in the UK has shown that big companies offer little care to the community, few career progression prospects for pharmacists or better priced products. They are only concerned about return for shareholders and will gladly increase prices once competition is killed off (ala Colesworth) and put profit before healthcare.

However, the current restrictions on the number of pharmacies any one pharmacist can own should be kept or tightened to stop pharmacists becoming greedy and the proliferation of ethically questionable pharmacists following the discount route, some of whom do seem to have abandoned any thought to health care delivery in the pursuit of increasing turnover.

Your vision offers no innovation and is just a partial rehash of the current trends in Australian pharmacy and the program of services being offered under the 5CPA, mixed with that old bureaucratic chestnut - renaming the govt department that administers it! (It's not the DSS it's Centrelink!)

Any substantial change in the pharmacy funding model such as allowing supermarkets in or NZ style payments will be a false economy and will cost the Australian tax payer a lot more in the long run.

Submitted by Rollo Manning on Wed, 01/08/2012 - 09:10.

Thanks for the well thought through comment Stuart.
However I think you have answered the question - is pharmacy remuneration fair and reasonable? No it is not although you say it is but then admit it is the "fat" that is paying for the add on features. Why is this? Why should the add on features not be paid for due to their importance to patient care?
Unfortunately there is no tabulated evidence of what pharmacists do along the lines you have articulated. It is all "anecdotal" and we live in an "evidence based" world. A PharmaCare government run agency would know what was being done and make sure that if you had an Approval you did these things and GET PAID FOR THEM. There are twice as many Approved Pharmacies in Australia as we need and forcing them to re-apply for an Approval Number would be the best way of sorting them out to the ones that really want to follow a clinical stream.
Thanks for your list of things you do and with your agreement I will keep this and use it in my lobbying.
Cheers
Rollo

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