s Pharmacy is Central to Primary Health Care and Self-Care | 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

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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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Pharmacy is Central to Primary Health Care and Self-Care

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.

I2P has been reporting on a range of systems that are able to determine a biometric for a patient from a home environment or from a pharmacy clinical space.
Refinement of these systems has been continually occurring to a level where they can now be said to be equivalent in terms of quality results compared to the more elaborate (and expensive) pathology laboratory.
Mature forms of these systems will be reaching the local market around the end of 2014 to mid 2015 and they will enable clinical pharmacists to position themselves front and centre for the delivery of primary health care and self-care health models.
The existing pathology model will eventually be totally disrupted (and replaced by the various biometric systems that can be used directly by patients) because the extended event chain, (doctor collection, pathology courier pick-up and return electronic report, new patient appointment and interview), is vulnerable and costly.
With various co-payments proposed by government for doctor consultations and laboratory pathology tests, many patients will fall through the cracks.

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Over 2013 media reports were indicating that many GP patients were not receiving a notification regarding their laboratory tests let alone being offered an appointment to discuss and interpret the results.

This lends credence to the proposition that there are many collaborative opportunities available where GP’s are unable to keep up with their work flow.
Why they are not offered to pharmacists is anyone’s guess.

But there is a major pharmacist opportunity to fill a void systematically:

1. Stock and sell suitable biometric test devices and systems.

2. Stock, sell and service suitable smart phones and note pads to run the biometric systems.

3. Develop and sell Internet cloud space to store patient results and allow patient access.

4. Provide an information service as a value add to each product or system.

5. Provide a results interpretation service for the patient.

6. Provide a suitable patient treatment that could correct any out of reference values documented. Ensure a reference to, and an update of the wider patient profile.

7. Provide referrals to other suitable health practitioners if the corrective treatment is beyond a pharmacist’s legal or professional ability.

8. Start an internal research program around the results that begin to build within your internal data storage and collection system, and share the results collaboratively in such a way as to pioneer new pharmacy clinical services.

A comment that recently appeared in Pharmacy News by John Bronger, (NSW branch president of PSA), stated:

“The Abbott Government is determined to cut healthcare costs and among the many targets identified in Treasurer Hockey’s budget is the primary and preventative care infrastructure built by the former Labor government.
As a health professional, I decry such de-funding, especially when it ignores evidence that investing in primary and preventative health has a strong correlation to economic growth – one of the Abbott Government’s stated primary agendas.
Nevertheless, this apparent wayward determination opens an opportunity for pharmacy. Because if key primary and prevention care organisations such as Medicare Locals get powered down, and the public are required to pay more for such services delivered by their GPs, which remaining network is best placed to hold the primary and preventative care system together under this new Coalition Government’s view of healthcare spending?”


There is no argument there, except that it will need a recognition that the clinical component (individual clinical pharmacist) will require nurturing, encouragement and incentivisation to deliver what may be required and support it with their own investment in knowledge, toolkits etc.
There is now a deep suspicion by accredited consultant pharmacists, that the PGA is not the appropriate organisation to drive or manage in any capacity, developing clinical services and the reluctance to form alliance partnerships precludes many opportunities from being taken up, at the moment.
i2P has been predicting this trend (with or without the Abbott government), for the past two years.

However, ignoring all of the politics for the purposes of this article, there is no reason why an owner-pharmacist or a contract clinical pharmacist could not provide a holistic diagnostics service to fill a basic need in the primary health care area.

The following system looks to i2P to be a well thought out system and one that we are moving to endorse once we have had the opportunity to do our own independent tests.
A San Diego, California-based technology company Cue has recently revealed its new product by the same name – a deep health tracking device that people can use to test and analyse small samples of their biofluids at home.

Cue allows patients to have their biofluid samples tested and analysed in real time and in any location. To use the device, people simply need to collect a tiny sample of biofluid — such as a drop of blood, saliva or nasal swab — with the Sample Wand that comes with the health tracking device, and then slide the sample into the cartridge. In just a few minutes, Cue can analyse the sample and then send the results via Bluetooth to the Cue smartphone app.

The deep health tracker is built with an advanced composite microfluidic system and state-of- the-art biosensors to enable it to convert a biological sample into information that is useful and significant to the user.

With Cue, users can track five health and lifestyle indicators: inflammation, influenza, vitamin D, fertility, and testosterone.

The Cue smartphone app presents the user with interactive charts showing information about their health. Users can also log in their food intake and their activities into the app. The app provides health alerts and reminders and even syncs with the user’s smartphone calendar and weather applications to give the user related information to help them stay on top of their health. Cue users can test themselves as often as they want and the app will be able to show them their health data and trends.

The Cue app also has a FluMap feature that shows the user a visualization of the spread of flu in their community. That way, users can prepare themselves and if Cue detects the Flu, they can get the proper treatment as soon as possible.Bluetooth Box Swabs The Inside Of The Nose For An Instant Flu Diagnosis

In a press release, Ayub Khattak, Cue co-founder and CEO, said,

"We created Cue as a tool for people who are interested in connecting with their health in a much more direct, intuitive, and powerful way than ever before. People can now keep daily track of measurements that used to be available only on a yearly or bi-yearly basis. We brought together the best minds and spent over four years creating the most advanced consumer health product we have ever seen."

 

Bluetooth Box Swabs The Inside Of The Nose For An Instant Flu Diagnosis

Clint Sever, Cue co-founder and Chief Product Officer, added,

"Our uncompromising focus on creating a simple user interface led us to develop incredible new technology that combines time-tested laboratory fundamentals with breakthrough hardware architecture, all packed into an amazing and timeless form. We worked to make sure that Cue delivered meaningful Information in a way that can be understood without a medical degree. The result of this approach is a product that opens up an entirely new world of possibilities for understanding and improving our health.

The health tracker is currently available for pre-order from the Cue website. Interested buyers can order Cue for a special pre-order price of $199, which includes a bonus set of cartridges, and expect their product to ship in the spring of 2015. The device will retail at $300 at launch. Buyers will also be able to buy additional cartridges and the travel case through the Cue website." Cue

The opportunity for pharmacists is not so much in providing the diagnostic tests themselves, but to assist the patient in the interpretation of results or trends.
Like doctors, pharmacists need diagnostic indications and trends to assist a patient manage their own condition.

The Cue system is a good fit for pharmacist reinforcement of its primary health care platform, as well as enhancing its self-care objectives.
Those accredited pharmacists who have had their “strings” pulled through non provision of pathology tests within an HMR referral, now have a bypass method through the Cue system.

Although the range of tests is limited for the moment, there is scope to increase rapidly.
Inflammation underlies a lot of lifestyle disorders (arthritis, Parkinson’s disease, asthma) and early detection of inflammation markers can enable patient referral to an appropriate specialist very early in the disease cycle.
Vitamin D3 is very widespread and is an underlying factor for progressing to a lifestyle disease.
Fertility disorders (both male and female) are reaching epidemic proportions.

With careful construction of a referral list and a strategic plan built around each test result, you can individualise and customise the extent of your clinical activity.
Organised on a sensible backbone, quite complex services can be delivered quickly and economically.

Any pharmacist wishing to become involved in clinical services delivery, please contact Neil Johnston neilj@computachem.com.au

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