s Pharmacy in the Home Opportunity emerging | I2P: Information to Pharmacists - Archive
Publication Date 01/09/2009         Volume. 1 No. 4   
Information to Pharmacists


From the desk of the editor

Welcome to the September 2009 issue of i2P E-Magazine - Information to Pharmacists.
In this edition I would point you to the Pharmedia link where trends in US pharmacy consumers are noted and matched to the Australian counterpart.
There is a strong similarity between the two countries.
In this commentary a direction and a strategy is suggested.
Please feel free to add your comment in the panel provided at the foot of this commentary, as it is a very important issue for Australian pharmacists.

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Another Step Back?

Neil Johnston

Anyone who has followed the story of convenience clinics in the US would have come to a simple conclusion very early in their investigations.

That conclusion would have been that with a few exceptions, the market being serviced in primary care was identical to that serviced by Australian pharmacists.

What was commonly known as “counter prescribing” in Australia became known as the “Minute Clinic” or Rediclinic in the US.

Now we have a development here in Australia where nurse-led clinics are being hosted by pharmacies, with the initial players being the Revive Clinic and the Pharmacy Alliance Group, consisting of 186 franchisees, all based in Perth, Western Australia.

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Pharmacies to write prescriptions? Yet another conflict?

Neil Retallick

The divide between who writes prescriptions in Australia and who dispenses them has traditionally been seen as an important construct in minimising any conflict of interest.
Will the evolution of nurse practitioners working in pharmacies mean that this protection mechanism for the average Australian (and their taxes) is dissolved?

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Location rules, regulation rules and money rules

Chris Wright

The National Competition Policy Review of Pharmacy has surely failed to protect the industry from itself.
The objectives of the restrictions include; “ Keeping pharmacy business small enough to facilitate the close personal supervision of their professional operation by the proprietor pharmacists.”
Oh, yeah, just how does that work?
And… “Protecting pharmacy businesses from perceived “unfair competition” and market dominance from large pharmacy-owning corporations and chains and, in some jurisdictions, Friendly Societies”.

Come on, let’s be serious!

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Advancing to garbage at the speed of light

Pat Gallagher

I am going to preach to you dear reader.
So what is new with that you will say?
Plenty, because I truly do believe in this creed, which is the belief that without rigorous control of core data integrity the whole e-health plot is flawed.
This boring subject has been raised in these pages several times and there is no doubt the message has sort of got through, but ‘sort of’ is way, way too far from being acceptable. You see this mishmash problem in the pharmacy daily as you use different PDE numbers for the same product when you buy from more than one wholesaler.
You cope with different proprietary product identification and then use the GS1 barcode, on the product pack, to close the sale at the POS (you do, you do use that barcode don’t you!).
All of this means you have to use the wetware technology tool to interpret and map information from one system to another; and the minute you introduce wetware you introduce errors.

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Pharmacy women’s Congress 2009 - Opportunities for learning

Karalyn Huxhagen

All of us have that neat stack of literature either beside our bed, under the desk or overflowing off the kitchen bench. If you are like me some are half read, bookmarked for later more in depth reads or stripped of relevant articles for pharmacy assistant training modules.
I also have a system with my emails and RSS feeds that categorises them to the ‘to be read when I have time file’. On a morning not so long back when I could lay in bed and clear this email in tray I completed a competition on the Pharmacy Daily website for the Pharmacy women’s Congress 2009. To my ultimate surprise I won!!

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The finish line of the Pharmacy Melbourne Cup is in sight…who will be the winners?

Garry Boyd

Comment about the future of pharmacy has been a daily occurrence for seemingly as long as Cook plotted a course up the eastern seaboard.
He hit the rocks, as will many of the so-called “players” attempting to seek proprietorship over parts of the pharmacy puzzle will.
Whether it be fact or Chinese whispers, a number of “core”(sorry Kev) “assets” have the attention of many.

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Paracetamol Problems in New Zealand

Staff Writer

Paracetamol overdosing is emerging as a problem in New Zealand similar to other western economies around the world.
In Australia we have seen some of larger chain pharmacies encouraging the sale of high volumes of paracetamol by deep discount, 
Despite protests from a range of pharmacists, little has been done to prevent the spread of irresponsible paracetamol sales.
Pharmacy Boards state they need an official complaint backed up with evidence of adverse events resulting from inappropriate selling.
Liver damage is one adverse event, sometimes requiring a liver transplant to rectify the damage.
There is no easy solution for paracetamol is such a useful drug.
However, there is a strong argument for confining all paracetamol sales to pharmacies irrespective of the potential inconvenience.
In fact, if the general principle applied that all medicines should be sold from a pharmacy, the need to sell other types of merchandise would dissipate.
It's worth a thought 

People overdosing on paracetamol

Source Otago Times

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Health IT Needs More Money - What's New About That?

Staff Writer

The consistent mismatch of approaches to Health IT continue to occur, even with the best efforts of Minister for Health and Ageing (Nicola Roxon) trying to uncover the best way forward.
Costs, both in the government and private sectors, have continually expanded to now stellar $ numbers.
Nicola Roxon's focus on the patient and building out from that point, will see her win the day.
Vendors (such as the Pharmacy Guild) who are canny enough to mould their systems to her view of the world, may eventually get a "nod" of some sort, provided the systems developed genuinely provide a scale of economy, saving development costs as well as delivering the specified benefits to health generally.
Commitment has been made to a National Broadband Network (NBN) and a 16-digit patient identifier so movement to shared health records is nearly possible, with the AMA making some "noises" towards a form of electronic health record (but not a full record).

Source: Australian IT


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UK Opposed to Direct to Consumer Advertising

Staff Writer

Proposals that would allow the pharmaceutical industry to provide drug information directly to consumers has been opposed by the Royal Pharmaceutical Society.
This against a EU background to develop an informational infrastructure that could be delivered to all of the European community.
A conflict of interest clearly exists between the public's interest to receive accurate and objective information and the pharmaceutical industry's objective of building revenue and market share. 

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NZ Considers Project Stop

Staff Writer

The New Zealand Pharmacy Guild has commented on the efficiency of Project Stop in Australia and wants to introduce it to NZ pharmacists.
They would also like to extend its use for other medication tracking.
NZ interest may further stimulate a faster uptake of the system in Australia, and by comparing notes in developing the use of the software, governments may be encouraged to fund a range of extensions.

Pharmacies Fight to Stop P-Runners
Source: Stuff.co.nz

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Health Insurers to feel the cold winds of change

Staff Writer

At last there is a move to sort out the high costs and inefficiencies inherent in Australia's private health insurance system.
Not that the private funds are totally to blame.
Government policies built around the Medicare levy (an extra tax, unless you take out private insurance), the limited range of benefits payable by private funds (because of government controls) has led to a high level of dissatisfaction by people privately insured.
It appears that an entity titled Medicare Select, may be utilised to negotiate and "bulk buy" health services, including those of the state-owned hospitals.
Private health funds, including Medibank Private, would be involved in managing the services on behalf of their members.
This new system has a real potential to reduce major health costs.

Medibank backs system shake-up

Mark Metherell
Source: BrisbaneTimes.com.au

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QUMAX –where to from here?

Karalyn Huxhagen

In April 2010 the current program for QUMAX (Quality use of medicine in aboriginal community controlled centres) will come to an end.
This was a pilot program and work is being done to look at where to from here?
Like all pilots the program took some time to achieve its goals but achieve them it did.
The evaluation process has been ongoing and the feedback from pharmacists and patients has been excellent.

Comments: 1

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UK Media Shutdown on Complementary and Alternate Medicine Information

Staff Writer

Will the issues revolving around complementary and alternate medicine (CAM) use ever be resolved?
Outcries from some respected science authorities deride all CAM as "witchcraft", yet most pharmacists would know of at least one good outcome from CAM.
For example, recent research into Traditional Chinese Medicine has uncovered the fact that some herbal remedies for the treatment of heart conditions, help to restore the nitrous oxide (NO) balance in the body, in part by converting nitrites and nitrates absorbed from foods, to beneficial NO (allowing proper dilation of blood vessels, subsequent reduction in blood pressure and gradual depletion of arterial plaque).
This information is now evidence-based, but will you see it appearing in mainstream medical publications?
It is my belief that while many critics of CAM definitely have a valid case for some complaint (particularly when patients are financially exploited), there are many "experts" that have been blind to information that could prove useful (and cheaper) for their patients, simply because they were unaware of the evidence available.
It is simply hidden from view under the sheer volume of total information that is being published and disseminated to health profesionals.
In February 2008 the respected BBC came under fire for providing information on CAM's and withdrew this popular service. I was unaware of this happening and have provided one of the media stories reporting the incident, for others who may have been unaware.
The BBC is a public broadcaster (like Australia's ABC) and serves the interests of the general population free from commercial pressure.
As 41% of people in the UK use CAM the decision to close down the service was certainly a controversial one.
A recent visit to the BBC site demonstrated some CAM news stories, mostly geared towards the potential problems that may be associated with its use.
This is a shame because the BBC are well placed to research evidence surrounding CAM's and provide a much needed and unbiased site for solid information.

Source: NaturalNews.com


The BBC Abandons Its Complementary Medicine Website Due to Pressure

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Software Licences Trigger Software Investment Review

Staff Writer

Many firms that licence key software programs are tightening up licencing conditions such as who is entitled to received free licences and what scale of charges apply.
Clients are reluctant to pay fee increases for basically the same software each year, but charitable and aged care organisations will be hit hard for licences that formerly were available to them free of charge.
Obviously there will be some hard negotiating coupled with a review of the actual software required.
One alternative may be to replace Microsoft with the Sun Open Office suite of programs that virtually duplicates the entire range of programs contained in Microsoft Office and comes entirely free of any cost. Open Office can also convert to any of the Microsoft formats.
Pharmacists may like to consider the change as well.

Source: Aged Care Guide


Aged Care IT Investment Put on Hold

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Supporting the Carers

Staff Writer

With the Baby Boomer retirement revolution due to start in 2010, one of the key needs will be an army of carers to provide home support needs.
Traditionally, this has fallen to family members, usually female.
And with a considerable number of carers being elderly themselves, there will be a human resource shortfall in this area.
One obvious solution is to elevate this activity to that of a career and the necessity to put training processes in place coupled with appropriate remuneration.
Government has made some moves in this regard, but not nearly enough nor in a timely fashion.
There is an opportunity for pharmacy to provide a support service in the form of "Pharmacy in the Home" services.
Creating the outreach is the difficult part, but pharmacies that do not try and participate will lose market share to those who do provide the service.

Carer at home issues raised by NHHRC reform proposals

Source: Aged Care Guide

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The Importance of Vitamin D3 in Aged Care

Staff Writer

A walk in the sun to generate a reasonable level of vitamin D3 is said to delay the need for a knee replacement.
But this vitamin is also implicated in heart health, cancer prevention, osteoporosis, arthritis and immune modulation, as in multiple sclerosis.
In fact, it is said that vitamin D3 is involved with over 1100 individual genes in an average person.

Even if you get sun exposure, if you utilise sunscreen preparations the conversion reaction in the skin is virtually negated, or if you have a shower 15 minutes after exposure, the vitamin washes away before being absorbed through the skin.
Old skin is also inefficient as a medium for generating and absorbing the vitamin.
While sun exposure is the cheapest and most optimal way of getting a daily dose of vitamin D3, a back up through oral supplementation is also recommended. 

Knee replacements delayed by sun

Source: Aged Care Guide


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Pharmacy in the Home Opportunity emerging

Neil Johnston

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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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:

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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