s Pharmacy in the Home Opportunity emerging | 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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Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
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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 in the Home Opportunity emerging

Neil Johnston

articles by this author...

Introducing current ideas, perspectives and issues, to the profession of pharmacy

The following story published by Drug Topics mirrors a trend that has already commenced in Australia.
A more conservative customer/patient is emerging, in part driven by government attempts to convert branded drugs on the PBS to a cheaper generic version.
Harsher economic conditions have also played a major part.
As we all know, not all customer/patients are convinced of the value involved in changing from long established brands, no matter what arguments are offered.
That means two distinct classes of health consumers are forming up within Australian pharmacies.
Note also that the value-conscious health consumer illustrated in the article is less impulse driven and creates a shopping list before leaving home.
And in the background, high levels of government stimulus spending means that the ability for government to fund existing and future services is at risk, and resources will have to be rationed even more than they are currently.
But this trend opens up a range of opportunities for pharmacists to develop a range of services targeted for customers/patients within their homes.
Mark Coleman discusses a "Pharmacy in the Home" concept further along this article.

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Economic woes affect retail pharmacy sales

Aug 28, 2009

By: Christine Blank, Contributing Editor
Drug Topics E-News

 Consumer shopping habits have changed in the new economy and some of those habits will have an impact on purchases of prescriptions and OTC healthcare products for the next few years, according to Thom Blischok, president of consulting and innovation for Information Resources Inc. (IRI).

“By the middle of 2010 unemployment will have stabilized. But we will see a new, conservative shopper among all income segments,” Blischok said during an NACDS and IRI-sponsored webinar this week.

 He said the new conservative shopper consumes six percent to 10 percent less across all product segments, makes more of his or her purchasing decisions at home, is looking for the best value on products, and is buying more private-label merchandise. Already, the “best value” proposition is affecting shoppers' purchases of healthcare and beauty products.

Over the last six months, 23 percent of consumers who have incomes of $35,000 a year or less said they had decreased their spending on healthcare products. And 17 percent of people who earn $35,000 to $55,000 a year said they have cut back on buying healthcare products.

Personal-care product sales have also been affected: 25 percent of those earning $35,000 a year or less have cut back on spending for personal-care products and 19 percent of those earning $35,000 to $55,000 a year have cut back, according to IRI.

Consumers surveyed by IRI also made these statements about buying healthcare products in this economy: “I look at the specials a lot more,” “I use coupons,” “If I get sick, I don’t have insurance, so I just get something over the counter,” and “I try to buy in bulk or ‘buy one, get one free,’ especially antibiotic creams…”

Another factor affecting healthcare product sales is that shoppers across all income segments are increasingly making their shopping lists at home, rather than making impulse purchases in stores. A whopping 83 percent of Americans are making their purchasing decisions before they go into stores. In the OTC healthcare realm, 67 percent of consumers surveyed by IRI said they are making purchasing decisions about pain relievers at home, along with 66 percent of people deciding about digestive aid products at home, 65 percent choosing vitamins and supplements at home, and 54 percent choosing over-the-counter cold medications and antibacterial creams at home.

“What does it mean for the retailer? You have to recognize how you are going to get into the home more. The internet plays a much more important role in helping people make decisions. The FSIs [freestanding inserts in newspapers] have to be retuned to be relevant to shoppers…and in tune to overall health and wellness. And signage in-store must match what is given on the Web,” Blischok said.

The trend toward private-label purchases is also affecting many OTC healthcare categories, with shifts being seen primarily in OTC allergy and sinus medications, pain relievers, bandages, and antibacterial ointments.

For example, over the past year, 15 percent of healthcare shoppers said they have switched from branded allergy and sinus medications to private-label versions, and 11 percent switched to buying a lower-priced brand. Three percent of healthcare shoppers have stopped buying allergy and sinus products altogether.

Blischok expects the “conservative shopper” trends to last for the next 18 months to four years. The good news is, however, that the conservative shopper will be spending more on certain healthcare segments in the future.

This conservative shopper is focused on preventive-care solutions, such as healthy food choices and weight management. These represent a significant opportunity for retailers who offer a comprehensive preventive-care program. “Preventive care is [worth] $100 billion and growing, and no one [retailer] has centered around affordable preventive care,” Blischok said.

In other good news for drugstores, shoppers are turning to drugstores when they're ready to buy their healthcare products. Fifty-five percent of approximately 720 consumers surveyed said they will visit drugstores for their healthcare needs over the next year, while 65 percent will buy their healthcare products at supercenters.

“Drugstores are the new convenience stores for women. You can go pick up your healthcare products, get a drink at some places, food at some places, and your prescription,” Blischok said.

Shoppers who talked to IRI said they shop at drugstores because in some cases they provide better value. “You can earn CVS ‘Extra Bucks’… Every little bit helps in this day and age,” one shopper said. Another shopper said she shops for healthcare products at a chain pharmacy because she “trusts the people there.”

 

Mark Coleman
I have been asked to comment on the points made in the above article.
US trends usually lead Australian versions, but in this instance, both countries appear to be in parallel.
This, despite the difference in health models in both countries.
In the US all drugs have to be paid for privately, while in Australia, we have the PBS providing subsidised drugs.
Even so, cost is still an issue here in Australia as people on low or fixed incomes are beginning to find difficulty in paying for their drugs and OTC personal and health items, as economic conditions begin to take their toll with unemployment continuing to remain high for at least the next 12 months.

Because purchasing decisions are increasingly being made in the home before the decision to buy takes place in the pharmacy, it is obvious that more sophisticated efforts have to be made to communicate with customers/patients in their homes.
Pharmacists need to be able to influence consumers to make good decisions for their health care purchases.

And the trick will be to mesh communications with the flow of activities within the home so as not to cause any disruption or difficulties.

Add to this complexity, 2010 officially marks the year for the retirement of the "baby boomer" population. Within 30 years, this population segment will be up to 30% of the total population in Australia.
Before the credit crisis hit Australia, this group of people held most of Australia's wealth and had very high levels of disposable income. While some investments involved with this group have been frozen, and superannuation funds have taken a king-sized hit, there is still a lot of financial substance left in baby boomers, who will progressively become more medically intensive as they finish a lifespan to a higher age than previous generations.

Customer/patient communications will have to be a precise and planned two-way process:

1. Customer/patient to pharmacy utilising traditional methods culminating in a visit to the pharmacy. Convenience of location will still have a strong bearing on patronage, and store ambience, ranging and price will all determine consumer choices in the traditional manner.
However, the Internet will begin to play a more important role. This is a non-intrusive method of generating consumer to pharmacy communications, also a method of providing health information and prices. Email will be involved either through a panel on your Internet site or by the consumer using their own system.
Purchases will need to be linked to a delivery service and this service will have to be charged on to the consumer (not provided free as most pharmacies now do).

2. Pharmacy to customer/patient: these communications will need to be be performed at convenient times and as much as possible, be integrated with communications noted in (1) e.g. the delivery of a catalogue and tick box order form to stimulate pharmacy purchases, should be made preferably with a pre-existing delivery, leaving the consumer to make their choice in the convenience of their home.
Order taking can then occur by telephone (initiated by the consumer), customer visit to pharmacy or timed for the next pharmacy delivery to the home.

So what is there that is different?

Not a lot at first glance, but there is a quantum difference in how economic delivery and communications systems are put in place.
People have to be trained and dedicated to different work flow aspects, including pharmacists.
A dedicated 1800 or 1300 service number will need to be in place and the marketing of the entire process has to be planned.
As the population ages, the ability to communicate accurate and timely drug needs will increase.
For example, visit this site to see how a dose administration aid can transmit important and timely information:
http://www.boston.com/business/healthcare/articles/2009/08/30/new_gadgets_prod_people_to_remember_their_meds

The use of dose administration aids (DAA's) in private homes will dramatically increase as the ability of government to fund nursing home beds is outstripped by demand, because of retired baby boomers rapidly expanding in number. Electronic communications linked to all stakeholders (pharmacist, GP, Community Nurse) through a DAA is just one unobtrusive method of communication with patients in their home (or managed apartment or retirement village). This can occur without the need to be located in a regional shopping complex - the home is the last frontier in terms of convenience and service location.
And it can extend further.
Research into sensor technology can transform the DAA communications system into a form of pathology service, with readings for serum electrolytes, glucose, INR, cholesterol etc being able to be transmitted by exception, when a patients reference range is exceeded.
At this point specialist pharmacists will need to be part of the team for interpretation and for consultation with other health professionals.
At a time when the Pharmacy Guild of Australia appears to be excluding the welfare of clinical (non owner) pharmacists from their business model, the presentation of a unified profession seems very distant.
Politicians well know that a house divided is a weak one, and as we approach 2010, the Fifth Agreement and the potential for some form of deregulation, there is little time to get an appropriate and inclusive model together.
Savvy pharmacy owners need to prepare for this electronic revolution, even providing training and investment into specialist pharmacist service businesses to ensure that their pharmacies will at least move up into the next stage of primary care - or it could default to specialist nurses.

Issues of preventive medicine and anti-ageing medicine will require specialist knowledge.
Pharmacy owners have difficulty in delivering knowledge type services because of the pressure created by dispensing and infrastructure management.
The concept of a community pharmacy providing core dispensing services and a proportion of space sublet to a range of healthcare practitioners, is one that would appeal to consumers looking for a quality health service.

For the moment, immediate plans should include the ranging of product sizes down to small and medium, deleting large sizes if appropriate.
Websites need to be planned and designed to handle the markets you intend to develop.
There is no need to try and match a Pharmacy Direct or an ePharmacy site - simply match your "bricks and mortar" limited offerings and ensure that there is a high proportion of generic brands in the product mix.
Offer information services on the website that can be pointed to during consultations.
Ensure also that the "bricks and mortar" site drives people to the website and the reverse.
This can be achieved with incentives, coupons etc. in either location.
If the pharmacy has a loyalty club, review it so that it is focussed more on target markets and ensure that it genuinely attempts to reduce health costs.

Patient profiles should include email addresses and a concentrated effort made to update all patient details including date of birth, allergies etc.
While most pharmacies offer some form of a delivery service, it should now be revamped and costed with hard decisions as to how much your customers/patients will be charged.
Getting the physical delivery service and its costs under efficient control will determine the winners in the Pharmacy in the Home development.
So, just do it!

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