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Regular updates from the global world of pharmacy.
Access and click on the title links that are illustrated.
Given the current climate regarding the PBS, now would be an excellent time to audit all your business processes and develop strategies to overcome imbalances that are occurring and will continue to occur for some time.
A specific area of audit is the prescription $ value as a ratio of total sales.
This index has been drifting out of balance for some years now so those pharmacy managers who have become complacent about this index will have to work out a quick correction.
Always in times of political pressure on PBS prices, pharmacists have expanded their commercial sales.
However, competition is so tough between the major retailers and warehouse style pharmacies, it is hard to find a niche to compete in.
But there is always a solution - find it!
Following on from the Rudd/Abbott debate on health reforms a great deal of expected commentary resulted.
One of the better versions was published in theage.com.au and is found at this link:
The article was written by Trevor Carr, who is chief executive of the Victorian Healthcare Association, that represents public hospitals, rural and regional health services, community health services and aged-care facilities in Victoria.
"The focus on beds and waiting lists ignores the role of primary care.Reform should move the health system from its current simplistic emphasis on hospitals and waiting lists to a system of interlinking elements that include acute care, primary care, early intervention, health promotion and illness prevention."
That statement is so sensible it is hard to think in any other terms. When Nicola Roxon first took up her position as Minister for Health and Ageing she came out in strong support of prevention, which meant a large slab of primary health care that pharmacy expected to be part of.
Her first foray was to establish GP super clinics.
They have been progressively introduced, but establishment costs seem to be a problem.
Also, the role of pharmacy within these clinics has never been properly negotiated or thought through.
Siege mentality seems to have paralysed senior managers and executives at the troubled Sigma Pharmaceuticals, the Melbourne based pharmaceutical wholesaler.
On the 19th March 2010, Sigma chairman John Stocker prepared the market for a shock prior to when it was expected to release its results a week later, but then subsequently delayed until March 31, 2010.
The results are expected to show a write down of all company assets to bring them into line with reality. Share trading remains suspended since February 25, 2010.
As recently as September 2009 Sigma gained an ASIC clearance to raise money without a full cleansing statement and enquiries are being made as to what part the company auditors, Price Waterhouse Cooper, played in this clearance.
Sigma raised approximately $290 million at that time.
The longer Sigma delays in giving a full explanation of its finances, the more the market will speculate and worst-case scenarios will continue to emerge.
The market was looking for a profit of about $92 million, but this year it will lose at least $150m after some $250m in goodwill impairment charges.
Goodwill is the amount paid over the book value of the assets.
It works if you generate better profits from the assets, or big brand names are involved, but it is not an asset in the conventional sense of a cash-producing item.
Market analysts have pinpointed three “black” holes in the company’s operations, which in combination may have tipped the company into a financial crisis.
There has to be something wrong when one-third of a local community signs a petition to get something done.
Such was the case in the Victorian town of Colac when three local women decided that the service from the two local pharmacies (having a common owner) had dropped to an unacceptable level, and that prescription prices had also reached an unsupportable level.
The Pharmaceutical Society of Australia (PSA) recently criticised the Pharmacy Guild of Australia (PGA) for not being open in their negotiations involving the Fifth community Pharmacy Agreement, after it discovered that professional service funding was being “skewed”.
As a result the PSA entered into direct discussions with government to claw back some of the funding the PGA was directing towards eRx systems in the guise that this was a professional service (but was really all about gaining ongoing revenue for the PGA executive).
The PSA was able to alter the balance towards true professional service activities and in so doing, showed an initiative that indicated that it would be involved in the leadership of the pharmacy profession.
After all, it does represent all pharmacists.
Consumers of pharmacy services are becoming more vocal in specifying the type and quality of service they require.
And they are making their demands felt, both individually and collectively.
Earlier this month we saw the community of Colac in Victoria rise up against a repressive business model that was being delivered – poor prescription service and poor prices.
Now we are seeing the Consumer Health Forum organisation raising concerns in a discussion paper just released, about the uneven delivery of services under the Fourth Community Pharmacy Agreement (4CPA) and they are asking for greater accountability under the 5CPA.
Health reforms proposed for implementation in mid-2010 focus primarily on doctors and hospitals.
For the moment it is difficult to see where pharmacy will fit in, and more importantly whether pharmacy will be ready to fit in.
The PSA has hinted that it has had some input with government and has stated it is developing a green paper, but unless it changes colour quickly and becomes a white paper, it means that pharmacy will have little to offer government.
The fact that the PGA was quick to jump in and identify eRx as a major pharmacy contribution belies the fact that it is a system deficient in some standards and because of that, will never be accepted by other health professions if they were to be involved with it.
It would seem that pharmacy in New Zealand has a lot of similarities to Australia as the following news item details.
Surely the message must get through to the decision-makers sooner rather than later?
Health programs in both countries generally have the feel of being pressure cookers about to explode with neither government seeming to have the political will to take the first simple steps i.e. actually make a decision
Source: Voxy News EngineNZ
NZ Pharmacists Can Fill Gaps To Help Reach Health Targets
Ever since I have known my wife, she has complained of cold hands and cold feet.
I am pleased to find that the Kiwis have discovered a reason for this.
However they think the problem is confined to Kiwi women, but I am able to tell them the problem is already existing across the Tasman.
However, the problem does have its serious side, so the story is well worth following:
Reform in health care seems to be an intractable problem.
The pace at which it is being introduced means that aged care facilities as we know them currently will collapse.
What then happens to the most vulnerable section of our ageing population?
Pharmacy has an ability to generate a “pharmacy in the home” program, but there is no coordinated effort to start this type of program.
Instead, there are too many power plays within pharmacy treading on boundaries between the profession and the physical infrastructure.
Compounding the problem further is a grab for “turf” between the professions.
The patient is way back getting lost in the sunset.
But optimism still exists.
The only eating disorder prevention program in the world to show long-term success when trialled on early teenagers has just been released by the Flinders University School of Psychology. Media Smart is an eight-lesson program that focuses on the manipulation of images in the media, building self-esteem and teaching young people how to analyse and challenge media messages.
The identification of compounds that could be promising candidates for drug development has become easier following research by the Walter and Eliza Hall Institute’s medicinal chemistry group.
Dr Jonathan Baell and Dr Georgina Holloway have developed a series of ‘filters’ that can be used to weed out those molecules likely to come up as false positives when screening a chemical library for compounds that could be useful in drug development.
Researchers at the University of Sydney's Centenary Institute have announced that they have made an exciting discovery that could lead to the first new drug for Tuberculosis (TB) in almost 50 years
Dr Nick West, of the Mycobacterial Research Group, is looking at the genetics of TB in the hope they will reveal a way to reduce the impact of one of the deadliest diseases in the world.
Dr West said when someone is infected with TB they either become sick immediately or the disease stays inactive.
"Unfortunately, the antibiotics we use to fight TB aren't effective against latent TB and can only be used when the disease becomes active," he said.
"This is a major problem as 1 out of 10 people who have latent TB will develop the active disease, becoming sick and contagious."
A University of Adelaide researcher has announced new national guidelines recommending that women at risk of early preterm birth use magnesium sulphate to protect their babies from cerebral palsy.
Professor Caroline Crowther from the University's Discipline of Obstetrics and Gynaecology and the Robinson Institute says the clinical practice guidelines are based on overwhelming evidence over the past 14 years that magnesium sulphate is effective in protecting the fetus.
"Five trials, including one funded by the National Health and Medical Research Council, confirm this finding," Professor Crowther says.
Thursday afternoon, 31st March 2010.
Thalidomide, the sedative blamed for tragic birth defects, treated a rare inherited blood disorder, according to recent experiment reports.
Around one person in 10,000 has a disorder called hereditary haemorrhagic telangiectasia, or HHT, which causes frequent, hard-to-treat nosebleeds.
Queensland University of Technology (QUT) research into the impact of climate change on dengue fever may lead to better control of the mosquito-borne disease.
Researchers from QUT's School of Public Health are examining the relationship between climate change and the incidence of dengue in the northern Queensland city of Townsville and the capital of Bangladesh, Dhaka, combined with their rapid socio-environmental changes.
Manly Vale pharmacist Lachlan Rose has been appointed to the NSW Branch Committee of the Pharmaceutical Society of Australia to replace Alison Roberts who has resigned to move interstate.
Lachlan is a community pharmacist at Manly Vale on the North Shore of Sydney and is a current member of the NSW Early Career Pharmacist Working Group, having previously held the position of President of the NSW Young Pharmacists Committee of the PSA.
While holding this position Lachlan contributed articles on student activities and opinion in i2P.
Allergy sufferers could soon be able to use their iPhone to scan a food’s barcode at the supermarket to determine whether it’s safe to eat.
The application being developed by Deakin University, GS1 Australia and Nestlé, will allow consumers to instantly access detailed product information including allergens such as wheat, egg, peanuts and shellfish directly from their iPhone.
Sigma is not yet out of danger and control is vested in its bankers.
Shareholders will be excluded from dividends in favour of debt reduction and the banks will be monitoring management decisions for some time to come.
This certainly reduces management flexibility but fortunately for Sigma its banks waived the breaches of covenants and renegotiated their facilities with re-set covenants, presumably agreeing with Sigma that its underlying results – a profit of $67.7 million was sound. Sigma doesn’t face principal repayments until early next year.
An unusual aspect of the overall result was that while underlying earnings were down 15.5 per cent, sales were up 4.5 per cent.
That can be attributable to the increased competition and discounting towards the end of the year to January that triggered the review of intangibles but Sigma also referred to some self-inflicted damage.
Dementia is a major health issue in Australia and is increasing in line with the ageing population.
One of the better government initiatives has been to plan and set up a range of Dementia Day Care Centres, the first of which has opened in Orange, NSW.
Given that over a lifetime we seemingly start and end in a similar state (i.e.childlike) it seems natural to find solutions for dementia patients in paralleling early childhood solutions.
We have Day Care for children now well established.
Day Care for adults will relieve the pressure for many carers and family members who act as carers.
NEW DEMENTIA DAY CARE CENTRE IN NSW
Source: Australian Ageing Agenda
Electronic health communications have had many obstacles to overcome, but we now appear to be on the home stretch.
Fumbling by government has been the main problem, because they did not seem to know what they wanted, leaving many private enterprise vendors trying to guess their way into the future.
This has proven very costly and extremely inefficient.
Even when the government formed NEHTA to plan and smooth the way, the right people did not seem to be at the helm.
Now NEHTA is talking to a range of major players and the e.health agenda is suddenly coalescing as it should have done, some years back.
Sigma continues to struggle to maintain its viability and obviously needs a “white knight” to come to its rescue with an offer of a friendly merger or takeover.
It is believed that some interest has developed for a transaction of this type, but may be less likely with most of the principal architects of the company's decline still in place
With the recent resignation of Mr Elmo de Alwis, attention is now turning to John Stocker (chairman) and Mark Smith (chief financial officer).
The US is well advanced in the delivery of electronic health summaries and their promised benefits.
However, protocols are being found deficient to preserve the integrity of the documents.
Short cuts in the assembly of a document involving a "cut and paste" from other documents are introducing inaccuracies damaging to the content as a whole.
The danger in "cut and paste" is that an error can be perpetuated and multiplied many times with the potential to cause major harm.
It would seem that a discipline has to be exerted through proper training, particularly by new users.
Australia has the ability to put the training steps in place in advance, to eliminate this potentially serious problem.
Doc calls EHR copy and paste function a "modern medical illness"
Source: Healthcare IT News
A funding agreement between the Australian Government and Edith Cowan University will see the $10 million GP Super Clinic established in Wanneroo.
Edith Cowan University will now work with the City of Wanneroo and the North Metro Area Health Service to begin designs and develop business arrangements and clinical services.
The Wanneroo GP Super Clinic, which is being jointly funded by the Western Australian Government, will deliver additional health services to the area to take pressure off the Joondalup Health Campus, and ensure local families can get the health care they need.
The Council of Australian Governments Meeting (CoAG), with the exception of Western Australia, agreed to establish a National Health and Hospital Network at this week’s CoAG meeting. The National Health and Hospital Reform Commission has recommended the development of a person centred, strong, equitable, integrated primary health care system and the college is pleased that CoAG has taken this challenge up. The CoAG communiqué is available at www.coag.gov.au.
A media release published this week indicates that there will be an oversupply of pharmacists of around 2009 in surplus within five years.
The release was based on a recent survey of which the author details appear in the news report below.
The last survey into the Pharmacy Workforce circa 2003 indicated there would be a shortage of pharmacists.
i2P reported on that survey and commented:
” The long awaited workforce report from the Third Agreement has arrived and the news is gloomy for those wanting an early retirement or thinking about cutting their hours back. By 2010 we'll be 3000 pharmacists short of meeting demand and as far as ever from filling the gaps.
I strongly recommend any pharmacists who intend to be practicing anytime in the next 10 years read though this report (A Study of the Demand and Supply of Pharmacists, 2000 - 2010). “
Well, we are progressing into 2010 and the projected shortfall of pharmacists did not happen.
Why then should we believe the current projection?
To develop some thoughts on this issue we have asked Mark Coleman to comment on the Pharmacy News report published on the 24th March 2010 which follows:
Dr Linda Bryant (PGDipPharm, MPharm, DPharm(Auck), FACPP, FNZCP, FPSNZ, MCAPA)
Linda is a New Zealand Clinical Advisory Pharmacist working as part of a team with GP's and nurses, in a medication advisory role. New Zealand clinical pharmacists get some encouragement to work independently in a variety of settings not necessarily tied to a community pharmacy. Through her company, Comprehensive Pharmaceutical Solutions, she contracts to Primary Health Organisations, lecturing postgraduate students in Clinical Pharmacy and undertaking evaluations of services. Linda's PhD thesis involved investigation into the barriers of implementing Comprehensive Pharmaceutical Care (clinical medication reviews) in primary care.
The opportunity for pharmacists to prescribe independently may be upon us sooner than we realise – like by the end of 2010.
Yes, that is this year.
I am very supportive of pharmacist prescribing, though personally would prefer collaborative prescribing because I doubt that pharmacists have, or wish to obtain, the extensive diagnostic skills required by a medical practitioner.
The opportunity for pharmacists to prescribe independently may be upon us sooner than we realise – like by the end of 2010.
But overall this has to be a way forward for pharmacy if we are not to be relegated to the role of professional shop-keepers, as nurses and others become more knowledgeable in medicines therapy, and also gain prescribing privileges.
Pharmacists must take the high ground and use their pharmacotherapy knowledge and understanding to become the experts in optimising the use of medicines – not just trying to get patients to comply with what another health care provider has prescribed.
Our practice nurses appear to be good at providing this adherence support role and working in nurse clinics that are now part of general practice, having time to spend with the patient.
Pharmacists must establish themselves as the health professionals with a high, and relatively unique, knowledge base and skill set relating to pharmacotherapy – our supposed area of expertise.
This is what differentiates us from other health care providers.
So, what thorny issues is pharmacist prescribing going to raise? (The following refers to prescribing in primary care rather than secondary care.)
Conflict of interest – access to third party payer funding
The first question is, can you prescribe and then benefit financially from the dispensing of the medicine?
There has always been a tacit agreement that ethically a medical practitioner cannot benefit financially from the dispensing of a medicine he / she has prescribed – from the perspective that if a third party (government) is paying, then the system is open to rorting and the over use of medicines.
I believe Japan had this problem when they allowed doctor dispensing.
This means that proprietors and their employees cannot prescribe and have the medicines funded through a third party.
Therefore, a prescribing pharmacist will need to be independent, preferably working closely with general practice.
We should be working towards having clinical pharmacists funded to work in general practices now, doing clinical medication reviews so that they become well placed to switch to prescribing pharmacists.
Nurses require a Master of Nursing degree, plus supervised experiential work to become a nurse practitioner (with prescribing privileges).
For pharmacists it is expected that a Postgraduate Diploma in Clinical Pharmacy, plus experiential learning will be the requirement.
One of the concepts that pharmacists will need to appreciate is that prescribing is for an individual, not a population.
While guidelines are useful for a general population, we need an in-depth knowledge of the medicines and the researched studies in order to individualise treatment … knowing when not to follow the guidelines.
If medicines therapy was simply following an algorithm, then an intelligent layperson could treat themselves (as indeed some try to do via the Internet).
Information sharing / collaboration
With concerns about the fragmentation of health care and current lack of coordination between health care providers, especially between primary and secondary care, then creation of yet another independent prescriber is potential hazardous.
Think of the patient under the care of a cardiologist, diabetologist, respiratory physician and rheumatologist, plus a general practitioner, nurse practitioner and a dentist, all prescribing independently and with the added possibility of these prescriptions being used in conjunction with OTC medicines and CAMs.
The risk of a drug therapy problem resulting in drug-related morbidity or mortality is great.
We don’t really need to add in another independent prescriber.
An electronic shared patient record is almost here, but the question still remains – who’s prescribing takes priority?
Therefore it is important that the pharmacist be prescribing within what is currently the most complete patient record – that of the general practice.
We will need to position ourselves within this collaborative environment, which is likely to be less threatening to medical practitioners than a competing independent prescriber located in the community pharmacy nearby.
I also see the prescribing pharmacist working as part of the team with the practice nurse, who focuses on the lifestyle issues for people.
So, how could prescribing pharmacists be helpful to general practitioners and help resolve some of the workload issues for general practice?
I imagine that repeat prescribing will be an important role – with the pharmacist managing the prescribing for people with long term conditions for three of the four quarterly visits, and a medical practitioner reviewing the patient annually.
Currently all our eligible patients have a cardiovascular risk assessment.
We could target those with a risk greater than 15%, and initiate what is currently guideline-based treatment and then monitor and individualise therapy as necessary.
The practice nurse could concurrently be addressing the lifestyle issues.
Similarly, the District Health Board I work in is considered the “gout capital of the world”, so the prescribing pharmacist could audit and then manage people with gout to achieve the target of serum uric acid concentrations less than 0.36 mmol/l. And so on ….
Responsibility and accountability
The biggest change is the move from making recommendations to taking full and complete responsibility for prescribing, and being accountable in a court of law for your decisions.
However, for pharmacists who make recommendations on changing a patient’s drug therapy, they should already realise that they are accountable.
Some general practitioners I work with, believe that if they enact my recommendations from a medication review, it is because they see me as a ‘specialist’ filling a gap in their knowledge.
Therefore I am equally accountable if my recommendation causes harm.
Prescribing pharmacists would no longer be able to hide behind the, “I only gave the information (or recommendation).
The general practitioner did the prescribing, so he / she is ultimately responsible”
So what will be the competencies?
Having appropriate clinical knowledge and understanding, with the ability to apply it to an individual, is crucial.
To initiate pharmacist prescribing I believe we will need to use the skills of those who are the current experts in prescribing – the medical practitioners.
I have asked some general practitioners about what competencies are required for prescribing. It is not simple and is about living with uncertainty.
It is not simply knowing about the medicines.
We will need all the help we can get from the current experts in prescribing, who incidentally tell me that it takes a number of years to feel somewhat comfortable with the responsibility and uncertainty of prescribing.
I shudder to think that there is a move in the UK to have newly qualified pharmacists able to prescribe immediately.
Medical practitioners are not prescribing fully independently until they are 26 or 27 years old – and they have been entrenched in clinical patient health care in that time, not a dual role (supply and distribution).
Prescribing is not a useful ‘add-on’ service to fill in time between doing other things.
It needs to be the primary focus of the pharmacist and undertaken in an environment that is all about patient focused medical care.
We need to be establishing the environment for pharmacist prescribing now – in general practices.Return to home