s Pharma-Goss for September 2010 | I2P: Information to Pharmacists - Archive
Publication Date 01/09/2010         Volume. 2 No. 8   
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Feature Contribution

Pharma-Goss for September 2010

Rollo Manning

Consumer welfare program or small business support program?

This is a controversial question that is sure to invoke hot debate.
It is to be welcomed.
Is the PBS a consumer welfare program as a part of a total National Health Scheme or a small business support program for retail pharmacies?
Where does the balance lie and is the consumer getting the best deal of the arrangements?
That is the question.
How dare such an assertion be made that suggests the Pharmaceutical Benefits Scheme may have lost its way and moved from being a part of a National universal welfare program.

Comments: 1

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Using "Exergames" for Stroke and Falls Prevention

Peter Sayers

"Exergames", like Nintendo Wii, are usually designed for fun, recreation and exercise.
However, they are gradually being transformed into tools to treat depression, assist in stroke rehabilitation and improve mental health-related quality of life.
Currently researchers are exploring the potential of "exergames" to reduce the risk of falls in older adults.
When people walk through their own environment they may be subjected to an occasional "trip" or "slip" that could result in a fall if people are unable to make an adjustment to quickly and accurately to recover their balance.
Stepping is something that few of us think about, yet our ability to step declines with age, increasing our risk of having a fall.
Now the same exergames are set to become medical tools linked to a range of health programs, hopefully connected to the National Broadband Network.
It struck me that this may represent an opportunity for pharmacists to be involved in the supply of this type of equipment and assist in the training and supervision of patients involved in this evolving list of programs.
It also provides a link with aged care and community nursing and may provide a useful service in a pharmacy-style walk-in clinic, providing pharmacists with a "hands on" entry point to patient care.
This lack of "hands on" activity often sees pharmacists ignored in the primary health care practice activities.

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The Road Not Taken

Neil Retallick

The American poet Robert Frost did not have the Pharmacy Guild in mind when he wrote this incisive poem, but I think the decision-makers at the Guild need to read it.
It may help them understand the far-reaching consequences of the choices they are making today.
Frost describes walking through a wood and coming to a fork in the road. He contemplates the two. One seems to be a little more worn, probably the more popular choice. The other is a little more grassy, chosen less often. Neither path showed signs of recent travellers. Frost chooses the less worn road knowing he will never be able to reverse this seemingly trivial decision. He knows that the rest of his life is irreversibly impacted by this simple choice. His history can never be re-written.

Comments: 1

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Social Inclusion

Rollo Manning

“Hey – don’t forget us – we were here first!”
Remote Aboriginals left out of inclusion agenda

Remote living Aboriginals and the cycles of disadvantage which place them at the bottom of the socio economic ladder in Australia must get special treatment from a new Government in Canberra. The fact that Australia’s first people are still living in “Third World” conditions in one of the wealthiest countries of the World is a shameful situation and only special treatment will raise their standards to a point where they can be considered “included” in Australian society.

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Wellness - What is the Pharmacy View?

Staff Writer

Pharmacy, in general. is a destination point for illness.
It has yet to spark consumer interest in the broad concept of wellness, and this is where consumer concerns are being increasingly directed.
An interest in "wellness" used to be something exotic. And to the extent consumers gave any thought to the concept, it was often defined simply as the absence of illness. But "wellness" is now very much a mainstream preoccupation, and one that's viewed more broadly as a marker for quality of life. A report released this month by The Hartman Group, a US-based consultancy/research firm that has made a specialty of analyzing attitudes and behaviors in this area, took a detailed look at what wellness now means to various consumer cohorts and how this affects their engagement with products and services, especially foods.
One only has to look at the Woolworths logo to realise how seriously wellness is being taken in Australia and why that organisation wants to create a health and wellness environment plus leverage the pharmacy destination point of illness.
This would create a model with a strong holistic image, attractive to a majority of consumers.

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NICM - An Umbrella for Evidence-Based Complementary Medicine

Peter Sayers

The National Institute of Complementary Medicine (NICM) is an organisation established to provide leadership and support for strategically directed research into complementary medicine, and the translation of that evidence into clinical practice and relevant policy, to benefit the health of all Australians.
It is an organisation that generates much needed credibility for the complementary medicine area and will do much to temper improper use of these medicines and moderate unwarranted criticism.
Polarisation of these two extremes has occurred, generating confusion among health providers.

Comments: 2

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The Right to Die

Neil Johnston

For the last decade, Australians have been talking about their average age increasing, to the extent that at least 25% of the population will be over the age of 64 within twenty years.
With that increase in age comes an increase in lifestyle illness and the need to invest in aged care facilities and to provide funding for medicines on the PBS that will increasingly be utilised.
It seems demand will outstrip available resources.
But another social/ethical issue accompanies the ageing process and lifestyle illness, and that is quality of life.
What purpose is there to living a long life if it has no quality or becomes too unbearable and draining for the individual and their surrounding family?
So when somebody decides they wish to die ahead of schedule because of unbearable pain and suffering they suddenly find that right has been taken away from them by politicians.
Euthanasia is a subject that has been kept under the radar for a long time but containment now appears impractical as evidence of suffering will simply increase with the volume of aged persons.

Comments: 3

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UK Walk-In Clinics Gain Traction

Staff Writer

Walk-in clinics in pharmacy is an idea that is now gaining traction around the world.
Long established in the US, they are now appearing in the UK - with one great difference - the UK model is staffed mostly by pharmacists with only a small number of nurse-led clinics.
All are funded by government.
If this type of clinic was to gain sufficient traction in Australia, plus receive government funding, an easing of the oversupply of pharmacists in some parts of Australia would possibly result, as well as ease pressure on GP's.
Boots, a chain pharmacy group in the UK is providing walk-in services during extended hours to ease pressure on GPs and hospitals.
Pharmacists at a Boots store in Edinburgh have started to provide walk-in services during extended opening hours this month as part of the Pharmore pilot project funded by the Scottish Government.
It's really just a more professional and properly resourced version of the old style counter prescribing, but this time in privacy, plus being paid for the service.

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Promising climate research awarded

Staff Writer

Dr Deanna D'Alessandro has been recognised for her promising research into climate change.
A University of Sydney researcher has won recognition for her groundbreaking work into capturing carbon emissions, which has the potential to significantly impact climate change.
Dr Deanna D'Alessandro, a postdoctoral fellow based in the School of Chemistry, is one of three female researchers to be awarded a L'Oréal Australia For Women in Science Fellowship.

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New therapy could combat the weight loss and muscle wasting experienced by cancer patients

Staff Writer

Deakin University medical researchers are working on a treatment for cancer cachexia, the debilitating weight loss and muscle wasting condition that affects patients with cancer.
Cancer cachexia has a major impact on quality of life for cancer patients. It can also inhibit the effectiveness of cancer treatments such as chemotherapy and radiotherapy.
There is currently no effective treatment.

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Prevention Saves Money and Lives

Staff Writer

University of Queensland and Deakin University researchers have  released a report with dozens of recommendations that strongly support more spending on prevention, but also warn that not all prevention measures are wise investments.
The Assessing Cost Effectiveness of Prevention (ACE-Prevention) project is the result of five years of research, funded by the National Health and Medical Research Council.
It is believed to be the most comprehensive evaluation of health prevention measures ever conducted world-wide, involving input from 130 top health experts.

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FIP Professional Innovation Grant

Staff Writer

Jonathan Penm, a PhD candidate at the Faculty of Pharmacy has just been awarded the Young Pharmacists Group (YPG) Grant for Professional Innovation 2010.
The announcement was made by the International Pharmaceutical Federation (FIP) Board of Directors during the 70th FIP World Congress of Pharmacy /Pharmaceutical Sciences in Lisbon, Portugal, which ran from 28th August to the 2nd September 2010.

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New Drug a Potential Treatment for Type 2 Diabetes

Staff Writer

Australian scientists, in association with US pharmaceutical company DiaKine Therapeutics, have shown that a drug candidate, Lisofylline, could be useful in treating Type 2 diabetes.
Drs Georgia Frangioudakis and Carsten Schmitz-Peiffer from Sydney’s Garvan Institute of Medical Research, tested the anti-inflammatory drug which is undergoing clinical trials for other diseases, on mice being fed high-fat diets.
Their findings are published in the journal Endocrinology, now online.

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Mobile Phone Technology - A Need to Integrate for Patient Benefit

Staff Writer

Mobile technology is advancing at a rapid pace and mobile phones in particular are now beginning to overtake fixed landline phones.
Some technology companies are now providing physical platforms to handle both mobile phone calls and fixed landline calls in a more integrated fashion, distributing all calls throughout the home or office using "hands free" extension phones.
The new platforms include other applications such as electronic diaries, Internet connection, Facebook and other social media extensions, weather displays, latest news displays, personal or other photo albums - the list is becoming very extensive.
Health technology developers now need to factor this expanding "tool" into their various architectures to ensure that they too are able to "keep in touch".
The mobile phone is now cemented into all age demographics, including "seniors", where it is regarded as an essential tool for keeping in touch with family and friends, and more importantly, for connection to their health professionals for emergencies.
I also notice that health professionals, particularly GP's and dentists, are using the telephone to remind patients of their appointments, usually a day or so in advance.
Health telephone systems need to become more intuitive to handle emergencies to bypass the normal blockages to a health practitioner in the event of an emergency.
A recent survey published in Retail Clinician indicates to what extent consumers would currently engage in an integrated and interactive system.

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Drug-herb interactions information available to all healthcare professionals

Staff Writer

MIMS Australia and IMgateway recently signed a Memorandum of Understanding (MoU) with the intention of delivering a unique Australian developed, evidence based drug-herb interactions database directly to a healthcare professional's desk top.
This database has been developed by researchers from the Faculty of Pharmacy at The University of Sydney.

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Health sector treats almost 6 million in flood-affected Pakistan

Staff Writer

The objective of WHO and health partners in Pakistan is to reduce avoidable death and illness
In a massive health relief effort underway in the flood-affected parts of Pakistan, nearly six million people have been treated for health conditions since the floods began in late July; but there are urgent needs to prevent further health crises or food insecurity caused by large-scale damage to crops and agricultural land.
"Increasing cases of communicable diseases, like diarrhoea and malaria, fears about children being malnourished, the massive disruption to healthcare, crop systems and rising food insecurity are the main health threats facing Pakistan's flood-affected people," says Dr Guido Sabatinelli, WHO's Representative to Pakistan.

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Kidzcomics-empowering kids (and possibly their parents)

Staff Writer

Children affected by serious diseases and medical conditions either personally or in their families often don't really understand those illnesses or the treatments required to fight them. New Zealand-based Kidzcomics aims to change all that with a series of comic books designed to explain medical information for children.
The Medikidz series features five superheroes by the same name, each of them a specialist in a different part of the body. With stories designed to be fun and appealing, the comics aim to entertain as well as educate children about serious medical issues. Conditions covered in the Medikidz line so far include leukemia, epilepsy, diabetes, HIV and ADHD, among many others; rather than “sugar-coating” the topics, Kidzcomics' books aim to empower and educate children for better self-management and less fear. All content is written by professional medical writers and doctors and then peer-reviewed.
And while the comics attract children they also serve to educate parents who sneak the occasional look.

There are currently more than 50 million children afflicted by illness in English-speaking countries.

Website: www.kidzcomics.com

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Water-Based "Artificial Leaf" Produces Electricity

Staff Writer

A team led by a North Carolina State University researcher has shown that water-gel-based solar devices – “artificial leaves” – can act like solar cells to produce electricity.
The findings prove the concept for making solar cells that more closely mimic nature.
They also have the potential to be less expensive and more environmentally friendly than the current standard-bearer: silicon-based solar cells.

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Exploring New Horizons

Neil Johnston

A message delivered to delegates attending the International Pharmacy Federation (FIP) Congress in Lisbon Portugal was for pharmacists to explore new horizons.
One can sense and appreciate this message because pharmacy does seem to be stuck in a time warp without a unified sense of purpose for the future.
Our two major peak bodies, the PSA and the PGA have not closely worked together, with open warfare being declared on occasions.
There does not yet seem to be a coherent positive theme running from either organisation that the "troops" can align with, although there are signs of positivity developing in PSA and a slightly lesser aggressive stance being taken by PGA.
But what's on your horizon and what is your future vision?
To help kick off a discussion, i2P asked Mark Coleman to comment on the media item reported in Pharmacy News on the 31 August 2010

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Pharma-Goss for September 2010

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.

Consumer welfare program or small business support program?

This is a controversial question that is sure to invoke hot debate.
It is to be welcomed.
Is the PBS a consumer welfare program as a part of a total National Health Scheme or a small business support program for retail pharmacies?
Where does the balance lie and is the consumer getting the best deal of the arrangements?
That is the question.
How dare such an assertion be made that suggests the Pharmaceutical Benefits Scheme may have lost its way and moved from being a part of a National universal welfare program.

open this article full screen

The truth is that there were 197 million PBS items supplied by 5,000 Approved Pharmacies in the 12 months to 30 June 2010. The amount paid in “dispensing fees” of $6.42 each item means the total paid out for this component of the total cost was $1.26 billion. Add to this the mark up on cost of let’s say $4.00 on the average price of $32.84 that adds a further $ 788 million. The Safety Net recording fee of $1.02 adds a further $201 million giving a total $ 2.25 billion of a total of $ 7.93  billion.

28% of the PBS spend, or on average $450,000 goes to each of the 5,000 Approved Pharmacies.

Is this a concern of too large a spend or a subject to rejoice at the size of the spend going to retail pharmacies. No doubt the Pharmacy Guild would rejoice and say that this is the cost of maintaining an efficient, sustainable (and “world best”) network of pharmacies to distribute the PBS to the Australian population.

Well let’s have a look at what is obtained for that spend across the socio economic sectors of the Australian population.

The higher income families or individuals living in the more affluent suburbs of the cities and regional centres have any number of pharmacies to choose from to obtain their PBS and no doubt have as good relationship with any number of pharmacies. Take Lindfield in Sydney for example where there are six pharmacies within a two km radius. These people will receive their PBS medicines together with counselling and maintenance of their Safety Net record - should they spend an amount in excess of $1265 in any one calendar year they obtain their benefits cheaper.

The middle to lower income families or individuals will obtain a similar service to the above group regardless of where they live – be it an inner suburb of a big city (Collingwood in Melbourne has four pharmacies within 500 metres of each other) or on the outer fringes of a rural town. Geraldton in Western Australia has six pharmacies within 1.5 Km radius. Plenty to choose from and obtain the same advice and support as the high income earners.

In small rural and remote townships where there is one pharmacy again the same amount of dispensing fee is paid and the clients can expect exactly the same service as the urban dweller. In fact their pharmacy will get an additional allowance to ensure its sustainability over and above the amount already paid as part of their share of the National average of $450,000.

But if that pharmacy in the “one pharmacy town” is not performing and another pharmacy is seen as being needed to provide competition – market forces at work – a pillar of the free enterprise way of doing things - the new pharmacy would have to be located 10 Kms out of town – yes out with the abattoirs, wheat silos or sewerage farm.

Aboriginal Australians living in urban areas get an added benefit of a reduced co-payment on the cost of their PBS because of their added risk of acquiring a chronic disease – and that applies to all people over the age of 15 years “at risk” – which means everyone. $88 million is to be spent on this added benefit for the 370,000 Aboriginal people in urban Australia in the next four financial years

The people who miss out entirely are the remote living Aboriginals in communities with NO Approved Pharmacy and no access to a quality pharmacy service like their cousins in the urban areas or remote/rural towns. For these 150,000 people their health clinic obtains its PBS from an Approved Pharmacy but unlike the urban dweller with access to a pharmacist (at $6.42 a script for advice) they get nothing and yet make up one of the most disadvantaged and multiple chronic disease sufferers in the whole of Australia.

The question really is how equitably is the $ 2.25 billion being spent? Is it necessary to have so many outlets in the cities, towns and suburbs and such ludicrous rules pertaining to supply to people in remote places? Why is there not some special arrangement for dispensing to the most vulnerable of all Australians – who are living in Third World conditions – the remote living Aboriginals.

This writer hopes that in the course of the next 4.75 years and towards the end of the Fifth Community Pharmacy Agreement, some action can be taken to refer the PBS back to its roots of being  part of a universal welfare program for ALL Australians and less of a “cash cow” for too many retail pharmacies. That is one opinion – what is yours?

Any reader who wants to join this discussion or dispute any of the stats, figures or claims made in this item are invited to advise the author and keep in touch. Contact rollom@iinet.net.au or mobile number 0411 049 872
A PDF file Fact Sheet of this article with illustrations is available on request.

Mental health a big issue

So pharmacists get in there and play a part in helping to forge better relationships between people, organisations and government agencies. This will be the key to a more harmonious population in the future and at the grassroots community level is the place to start.

A full page advert in the daily newspapers listed 65 organisations that are members of the Mental Health Council of Australia and NO pharmacy organisations are included.

How long does it take for the so called peak organisations to take their responsibilities on behalf of the profession seriously and start talking to others?

The Pharmacy Guild talks about its key role and this is challenged by the Pharmaceutical Society of Australia saying that it really represents the total profession.

Maybe it is time for both to stop arguing and get on with liaising with other key organisations. The mental health of pharmacists is at stake and better relationships will go along way to building better links and forging partnerships.

For those interested have a look at the full page ad can be seen at

http://www.mhca.org.au/documents/MH_end%20the%20neglect_A3_print3.pdf

As this columnists likes to say –“It is not until you are out there doing it that anyone will know what you can do”

In terms of the future we must be talking with others and not just doing research is our own little cocoon of medicine supply experts – even this can be questioned. Any number of “roadmaps” and “paths to the future” will be worthless if the basic direction is flawed and end goal not clearly articulated and agreed with the profession as a whole.

See next item – A future role for graduated pharmacists.

A future role for graduated pharmacists
The Early Graduated Pharmacists Group of the Pharmaceutical Society of Australia is to be congratulated on its stand in seeking a wider role for pharmacists in primary health care. Just because a person is a “pharmacist” does not mean they have to be confined to the supply of medicines. The degree of Bachelor of Pharmacy should be only the starting point of a career that could take the holder anywhere in the health sector of the economy. People holding the degree can be found in over 12 different government departments at both the State/Territory level and Commonwealth public services. Jobs for policy officers are being continually advertised is areas of expertise where pharmacists have a basic training. Give it as go. If you would like to see more of the opportunities that exists and training options needed or offered to do the work effectively write to the author at rollom@iinet.net.au for a list of opportunities.

QUOTE OF THE MONTH

If a free society cannot help the many who are poor, it cannot save the few who are rich.
John F. Kennedy
(1917-1963, 35th American President)

Return to home

Submitted by Karalyn Huxhagen on Sat, 11/09/2010 - 10:43.

Hi Rollo raises a few issues that are still on the table even though a lot of money has been spent trying to make the access to pharmacy services more equitable for all Australians.

We now have several systems in place for the Aboriginal and Torres Strait Islander people to access pharmacy services. We have section 100 supply in remote communities which is the most ass about system in terms of providing quality pharmacy services.

Then we have Closing the Gap services for PBS copayment for urban dwellers, public hospital supply and QUMAX that provides other services like DAA's and access to pharmacy services.

So in fixing one problem we have created another as there is no connectivity between these programs. Therefore the more mobile of the Aboriginal and Torres Strait islander people are accessing different systems with different eligibility rules and payment structures. It is confusing to say the least.

In some communities we have different systems being managed by the practice as the outlying station is remote while the central Aboriginal health service is urban.

Then there is the Australian Pharmacy Council report " Remote/Rural Pharmacists project Final Report 2009" which provided recommendations on alternative modelling for pharmacy services in remote and rural communities. All major bodies including the Pharmacy Guild of Australia were part of the working party that developed this report. The PGA has publicly claimed that the APC report has no worth and dismissed its outcomes.

These issues have also been raised with the Australian Health Ministers rural steering group in a series of workshops around Australia

A lot has been done in the past 10 years but we still have a very long way to go.

Pharmacy services to outreach areas of Australia is not a pipe dream that can never be solved. There are so many models that already work in small pockets in both Australia and with other cultures like the indigenous people of Canada and America.

What we need is a willingness to look at the whole package of health services in these locations and develop protocols that allow pharmacists to do more than drop off a bundle of drugs (S100).

we can be providing health screening services, immunisation, chronic disease monitoring and oh so much more

I had hoped that the current Minister would have seen the opportunity for pharmacists expanded roles in what he has been presented with but alas the funding has gone to GP services and Divisions of GPs once again!!!

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