s Pharmacy Clinics Becoming a Reality | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
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

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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 Clinics Becoming a Reality

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.

Editor’s Note: Pharmacy has been talking about installing clinical services within its environment since 1978, when the PGA first identified three pharmacy models for the future – the traditional model, the supermarket model and a clinical model.
Mysteriously the PGA walked away from the clinical model and endorsed the supermarket model. Small pharmacy owners were disparaged, disadvantaged and discouraged over the following years.
It is now 2011 and the first glimmerings of funding support for a clinical model is now emerging from the Fifth Community Pharmacy Agreement.

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In 2000 i2P warned that the growth in the nursing profession through clinical nurse practitioners was about to burst upon us in a competitive fashion.
Shortly after, a rash of US-based clinics began opening in supermarkets and large pharmacies staffed by clinical nurse practitioners began to develop rapidly.
Success was mixed, with many openings and some closures.
On balance, the clinics have settled down to become a health success story.

Progress in Australia was somewhat behind the US, but a few years ago Revive Clinics opened in Western Australia under the direction of Louise Stewart, and a toehold of nurse-led clinics established themselves within pharmacy environments.
On November 1 2010, professional services provided by these nurses became reimbursable through Medicare.
This marked the real starting point for this type of primary care service.
As you would imagine they were not popular with GP’s and a series of harassments have occurred like the one illustrated in the Medical Observer story below.
i2P has asked Mark Coleman to offer some comment (below the news story) that appeared late last year.

Source: Medical Observer

Nurse medico-legal risk under scrutiny

Caroline Brettingham-Moore   all articles by this author

1 comment

Doctors’ groups will be seeking urgent clarification around the medico-legal risks of collaborative arrangements with nurse practitioners (NPs) when they meet with medical defence organisations this week.

The AMA-convened summit comes amid growing concern that GPs could be unwittingly exposed to legal risks when working with or obtaining test results from independent NPs outside of collaborative arrangements.

Representatives from doctors’ groups, nurse groups, medical defence organisations and the Federal Health Department are expected to discuss a number of scenarios involving NPs, including working with the Revive Clinics.  

Their ongoing concerns were highlighted last month when a Perth GP received a pathology report, ordered by a Revive NP, without her knowledge and without any notification.

“I haven’t agreed to any collaborative arrangement… [but] it was my duty of care to follow up and make sure that [my patient] was getting treatment,” Dr Fran Connolly told

MDA National medico-legal adviser Dr Sara Bird confirmed GPs had a legal obligation to review their patients’ test results to determine if any action was required, regardless of whether they had entered a collaborative arrangement with an NP.

Tasmanian GP Dr Graeme Alexander – who recently wrote to pathology and radiology providers in his area advising them that his practice would not accept reports requested by NPs – urged GPs to proceed carefully, believing the incident would not be the last. 

“For anyone to say it will be a one-off example is just being dishonest,” he said.

RACGP president Professor Claire Jackson said in setting up the legislation the Government had failed to adequately consider the medico-legal ramifications for GPs, with too much focus having centred on protecting NPs. 

Professor Jackson said she hoped the talks would address GPs’ risks and concerns.

AMA vice-president Dr Steve Hambleton said the AMA would also seek clarification on whether independent NP-led clinics were “in the spirit of the legislation”.

“The issue for us… is that some business models that have been proposed should not meet the criteria [for MBS rebates],” Dr Hambleton said. 

However, Revive managing director Louise Stewart again defended her company’s business model, saying it met government requirements on collaborative arrangements.

She also said the Perth incident was a failure of the individual NP to follow Revive standard protocols, which involved sending explanatory correspondence to the patient’s GP with the results.

The talks also come as a new study on patient attitudes published by the Menzies Centre for Health Policy found that 84% of 1200 Australians surveyed would attend an NP-led clinic if it offered more convenient access than a GP.

Mark Coleman:
I am asked to comment on the above story because it has taken to this point in time (since the above article was published) for doctor groups to mobilise and become highly critical.
The RACGP has responsibly set out guidelines and a template for a collaborative agreement.
However, these agreements will probably need constant upgrade to truly take to account the perspectives of other health professions and to acknowledge the skill sets they bring to the table.
The months between the Medicare funding announcements up until now, have progressively become more GP-hostile to the Perth-based Revive group of eight clinics.

When the RACGP guidelines were released, a Perth GP billed one of the Revive clinics $47 for a two-minute phone conversation he had with a nurse practitioner about his patient, who had been given an injection at the clinic. 
Other instances of this type of GP vitriol have been experienced.

Louise Stewart has commented that there was a “real attitude of aggressiveness” to the extent that she feels many of her GP critics want to see her fail and are contributing in any way possible to accelerate that possibility.
Some of their published comments are worth reading, because the spread of vaccination clinics through the Priceline pharmacy group is now imminent and trench warfare will exacerbate, until the lid is put back on to close off GP behaviour.
The ACCC have become interested in some of the activities in Western Australia and have begun an investigation. Louise Stewart has said that she is not keen about the investigations and has expressed publicly the point that she believes her Revive group can work collaboratively with doctors.
The ACCC is the only organisation that can create a level playing field and it should actively do so if Australia is to end up with a decent health system.
Pharmacists may also need ACCC help, as they provide infrastructure for the clinics and may develop some of their own primary care activities.

Well, good luck Louise, because it is quite apparent that GPs collectively are one of the major reasons for the high cost of health in Australia and in many other parts of the world. Their manipulation of other health practitioners has been endured far too long and the balance needs to be redressed

Because these primary care clinics are generally hosted by pharmacies and will now proliferate rapidly throughout Australia, pharmacists may have to carefully consider their positions:

* Doctor anger will extend to all of those who are associated with any non-GP primary care clinic. The management of professional relationships will need to be carefully and professionally evolved to ensure pharmacy goodwill is enhanced rather than dented.
However, because it is time to redress imbalances in the health system, pharmacists must remain strongly assertive throughout and not cave in to any GP pressure.

* Pharmacists must carefully consider how much of the primary care market they are willing to concede to clinical nurse practitioners. Pharmacists have always had a hidden market in primary care, and because of this it has never been “seen” by other health professionals.
Some of the market has eroded because a lot of the “counter prescribing” developed by senior pharmacists has not been able to be passed on to new entrants into the profession. This has mainly been caused by the pressure of a PBS system that has pharmacists doing a lot of work for a government department, that is non-clinical work and works against professional development.

* Pharmacy owners will have to consider to what extent they will support their non-owner colleagues to establish practices similar to the nurse-led clinics or in collaboration with them.
Collaboration, rather than competition would seem to be the better option as each of the professions brings a different set of skills and perspectives that together, will make up a better “whole”.
Pharmacist practitioners will also have to obtain prescribing rights similar to the nurses.
Ownership can never be an option for a pharmacist-prescriber because of the potential for conflict of interest. The PGA has yet to alter its stance in this area towards pharmacist-practitioners.

* The Priceline pharmacies will launch their no-appointment service in early April through 120 of its pharmacies, where patients will be able to buy the influenza vaccine without needing a prescription. The service (costing $30) will be available from March to May 2011 for 15 to 64 year olds and the vaccine will be administered by accredited nurses. However, this service has also attracted the usual criticism from the AMA who says the patient’s safety could be put at risk by administering the vaccine outside of the general practice setting. This is just a nonsense.

* Pharmacists will have to tidy up their internal marketing e.g. a clear definition of who is a patient and who is a customer and a clear separation of professional services from commercial services and activity.
This requires the development of suitable privacy spaces for consultations and development of new staff (the clinical pharmacist and the clinical assistant, as distinct from the dispensing pharmacist and the dispensary technician).

* All the dramas of keeping pharmacy front and centre appears to be resolving in the US. A recent March 2011 article in  i2P  “Clinical Pharmacist Roles Surging Ahead in the US” illustrated that funding bodies now expected to negotiate with doctors, nurses and pharmacists collectively (not just doctors as a lead group) for the provision of clinical services.
This was a rapid turnabout resulting from two large scale trials of collaboration that were highly successful. For the first time it highlighted the fact that pharmacists were the gatekeepers of most of a patient’s drug history (through script records) no matter which health professional they consulted. This was never thought to be so previously and severely dented doctor claims to be the “font of all patient knowledge”.

Pharmacists are advised to get on board any clinical service offering they can be involved with.
They will take some time to develop into a model suitable for a community pharmacy environment, and the PGA has yet to come round to the support of private pharmacist practitioners.
I believe the ideal model will prove to be a working partnership between practitioners and pharmacy owners allowing each side of the partnership to develop to full potential. That partnership should extend to clinical nurse practitioners and that could result in a service that may prove more acceptable to patients than that of a GP.

I guess that is the worst nightmare a GP might experience.
We all have to change- and the sooner, the better.

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