s Pharmacy Pressure Points - Are They are Building out of Balance? | 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 Pressure Points - Are They are Building out of Balance?

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.

As a pharmacy owner you must have the ability to monitor three broad areas of your business.
These areas are titled simply as Policy, Market Planning and Capital.
These are the pressure points in a pharmacy business where pharmacy managers must always be seen to apply positive pressure.
If pressure is not applied and becomes negative, business balance is lost.
Depending on the severity, it is appropriate to rebuild that positive pressure and keep the business in balance and under control.
If control  begins become difficult, all efforts and strategies must be employed to break the existing cycle.
Speed of reaction is the essence.

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Policy is an ongoing process, and while a business at the small end of the spectrum can survive by delivering a certain number of policies verbally (as opposed to writing them down), no business can survive if there is not an actual trigger to identify that a policy is actually needed, coupled with a regular rotational review of all existing policies in place.
The most obvious time to generate a new policy or tidy up an old version is when something adverse happens within the pharmacy.
That is the trigger!
So if a customer leaves your pharmacy in some distress you need to find out why, through first generating an incident report, followed by a written policy, to prevent a future occurrence of the same problem.
All staff should sign off on that new policy and the document filed appropriately with other store policies.
Once the policy has been completed, reinforcement should occur by applying a value analysis with the person(s) at the centre of the incident.
Ask the questions. How? When Where? Why? Was it necessary at all?
The purpose for asking the questions is to have the staff person(s) virtually solve the problem through logical thought, and more importantly, is able to leave the analysis having a full understanding of the problem - it being indelibly printed to their conscious thoughts.

If the above process is not an ongoing one in your pharmacy I would say that it is time for a refresher course for you in management theory and practice.
Mismanagement is the main cause of all business problems, and while a manager may think that a procedure has been successfully delegated to a subordinate, unless there has been a planned follow-through, the delegation inevitably unravels.
The decision to generate policy should never be undertaken as a punitive measure, because poor management is at the root of it.
Policy should be generated as an educative activity and be introduced through a mentoring process.
If the above activity has not been ongoing in your pharmacy then believe me you already have a lot of underlying problems that are about to become spectacular through any external influences e.g. the sudden loss of gross profit that will occur in 2012 when generics take up to a 29% price cut.

Market planning is also an ongoing process and involves forward-looking thinking and strategies.
Unless it is undertaken, you wake up one day finding that your opposition has left you behind.
When you try to catch up by copying your opposition, it takes a little while to realise that you are flying blind. Simply put, your opposition is working to a plan, and you have simply followed on without full understanding.
In that state you are forever at a disadvantage and until you are in a position to convert your role of “follower” to that of “leader”, your market share and profitability will always be under pressure.
All that is required is a little bit of imagination and creative thinking, plus a willingness to embrace new ideas.
Work out the steps required to develop changes to your marketing strategies and the structure of your business model to facilitate those changes.
An overall business/marketing plan should be freshly documented each financial year with the facility to upgrade every three months or other suitable time interval.
The first business plan is always the hardest, but put in the time, and all subsequent upgrades or re-writes are always much easier to produce, and far less time-consuming.
The pressure for the moment is to find a range of markets that will generate higher margins to offset gross profit losses that will occur beyond April 2012.
If possible, they should relate to professional services that can attract a fee for service that will bring a focus back to core business.
Something that can be leveraged off dispensing is probably the starting point, but not in the fashion of the PGA/Blackmore’s proposal (coke and fries) which has done considerable damage to the professionalism of pharmacists.

Capital is also an ongoing process. and it is the life-blood of any business.
“Stay liquid and stay profitable” is the golden rule for any business.
Recently i2P published an article titled “Financial Stresses in Pharmacy- It’s Part of a Cycle)

It was reported in that article that conservatively an estimated 1000 pharmacies (20% of the total of all pharmacies within Australia), can identify with the tag of being financially stressed. It's never happened to that degree before.
Of the financially stressed, 20% of those are drowning or under administration of some sort.

The following notices that appeared in the newsletter Pharmacy Daily testify to some of those pharmacies in distress:

12 September 2011

PHARMACY FOR SALE
RECEIVER & MANAGER APPOINTED


TWC Charlestown Pty Ltd

T/A Terry White Chemists Charlestown, is being offered to the market for sale.

7th October 2011

PHARMACIES FOR SALE
RECEIVER & MANAGERS APPOINTED


• Chemist Depot Grand Market Bankstown

• Chemist Depot Appian Way Bankstown

• Priceline Pharmacy Bankstown

• Chemist Depot Top Ryde 

Without having undertaken any further investigation it can be categorically stated that the above distressed pharmacies arrived at that point through mismanagement, part of which arose from the lack of a business plan.
The main problem would have been because they tried to follow the business model of a business like Chemist Warehouse mindlessly.
Not that Chemist Warehouse is immune from the above comments, but they do have more collective resources than the operators of those distressed pharmacies, and will last longer (but not necessarily permanently).
Alarm bells should be ringing to all pharmacy owners that they should return to an original business model of their own design with a unique marketing plan that embraces a suitable gross profit component that creates survival.

A suggested survival plan should embrace the following activities:
(i) Audit the number of inventory lines held and liquidate all that have lost a stock turn below a nominated figure (suggest 3 as a minimum). Liquidate at the best price obtainable (usually half retail price) and do not reinstate in your permanent inventory.
You can still order them as a “once-off” purchase for that special customer, but do not hold stock!
Also, over time, review your prices upwards and remove all guarantees to beat or match other competitor prices.

(ii) Negotiate now with your major suppliers so that you can vary your terms of trade e.g. ask if you can pay half the monthly statement on the normal “date due”, 25% after a further 10 days and the final 25% after a total of 20 days.
This variation may be accepted by your supplier provided it is honoured without exception.
Both you and your supplier may survive with that type of variation and it may just allow your cash flow to expand to a level where you are able to control your creditors.
Negotiate now, because to leave it until April next year and default may simply take you into the distressed state and be published in an advertisement similar to the above.
Negotiate now, even if things are not critical.
Squeeze your cash flow until you get a sufficient volume to place on a fixed deposit.
Use this fixed deposit as a guarantee for a “come and go” overdraft facility with your bank.

(iii) Organise a corporate credit card but only use it as a bridge for those occasions when PBS claims do not arrive on time, or similar circumstance.
Do not use it unless you know that incoming funds will be forthcoming.
It is more for use as a “smoothing” tool between the peaks and troughs of the cash flow cycle.

(iv) Create an emergency fund by recruiting capital from the family. Fix these funds as an interest bearing deposit to use as a last resort to secure an overdraft when circumstances become desperate.
The interest accrued becomes income for the family lenders

With a proper business plan that includes projected trading and profit & loss figures as well as cash flow projections, you will stand more chance of getting a proper long-term facility from your bank.
Selection of bank is also important because some banks are now not “pharmacy-friendly”.

(v). Liquidate assets that are non-productive e.g. that holiday house that only gets used once a year.

(vi) If debtor accounts are substantial it may be possible to free up some cash flow through factoring the outstanding balances.

Whatever you do get advice and do something!

Don't get caught out early in 2012.
Plan your capital requirements and update your financial projections this side of Christmas.

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