s Pharmedia: Patients won't swap GPs for pharmacist consults | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

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

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News Flash

Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated

Comments: 1

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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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Pharmedia: Patients won't swap GPs for pharmacist consults

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: There have been two articles recently in Australian medical media regarding clinical services for a fee through non-medical practitioners. The first being was by a standalone nurse practitioner clinic that closed after only a few months of operation.
The second was simply about a survey asking for comment on pharmacist clinical services. This involved one researcher from Flinders University in Adelaide and a small sample of the general public. The survey was conducted in Glasgow, published in the BMJ and reported in Australia through the e-pages of 6Minutes.
It was thought that this item was worthy of comment by Mark Coleman.
The media item follows and Mark's comments appear after the media item.

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6 Minutes

http://www.6minutes.com.au/news/latest-news/more-trust-in-gps-than-pharmacists

Patients won't swap GPs for pharmacist consults

15 May, 2012 Gemma Collins

The public has more trust in GPs than pharmacists with the majority of patients preferring to see their doctors for screening and consultations, new research suggests. 

A study published in the BMJ found that the general public would prefer to consult a GP rather than a pharmacist for most primary healthcare needs, with many viewing GPs as offering “safer services” and a more “complete package of care”.

The UK
study which involved a researcher from Flinders University in Adelaide surveyed a small sample of the general public in Glasgow.

The researchers found the majority considered the pharmacist’s central role was medicine supply and said they would only go to their pharmacist for ‘low risk’ services such as for minor ailments and smoking cessation.


They preferred having an honest and open discussion with their GP and were less likely to discuss sensitive topics with a community pharmacist.


And many raised concerns about going to pharmacies for health screening including blood pressure monitoring as they thought it wouldn’t result in prescribed treatment or be recorded in their medical records.


“Some perceived that trusting pharmacy services could, therefore, seriously threaten their health,” the authors say.


“In addition, most considered that the GP would repeat diagnostic tests carried out at the community pharmacy, rendering a visit to the pharmacy unnecessary”.


A familiarity with a GP promoted trust, the researchers found, which is common in the UK due to patients having to be registered with a doctor.


But many participants also considered the pharmacy setting did not offer enough privacy for confidential consultations and health screening.


The authors suggest that public trust could improve if community pharmacist services were endorsed by GPs.

Mark Coleman

I am asked to comment on the above media item.
I often wonder what goes on in the minds of GP's because they seem so insecure when someone from another area of health decides to offer a different or an amplified version of one form of health delivery.
Siege mentality seems to set in with rumblings about "turf wars" and the negatives of a non-private pharmacy setting, even the lack of diagnostic tests that would require a second visit to a doctor's surgery.
These comments assume that before offering any upgraded service a pharmacy setting would remain the same.
If that happened, then it is quite likely the service would not take off - but that is not what will happen.
Recently a nurse practitioner service closed down and was replaced by a GP clinical service.
The reason given was an insufficient return because the Medicare fee was too low, but it also appeared that the clinic did not attract sufficient patients to make a go of it.
Whatever the reasons for failure, the service had only been in place a few months - insufficient time to actually grow any service.
Pharmacists have been providing consultations for many years (I have been providing such a service for 50 years) but with some major differences to their GP cousins:
(i) The service was provided informally on the request of a patient, and was generally provided at no charge to the patient. Often these patients would offer to make a payment and have been surprised when their offer was declined. This type of service, in marketing terms, was simply provided as a "loss leader" to enhance prescription patient services.
(ii) Because there was no intent to create clinical consults as a business competitive to a GP clinic, these services were provided with no special infrastructure.
If clinical consults were to be formalised, then reasonable infrastructure would need to appear to incorporate privacy and confidentiality, time allocated by appointment and targeted offerings developed. A fee would have to be charged.
Pharmacy clinics initially would be created in pharmacies with existing infrastructure and personnel to "sell" the service. Existing pharmacy dispensing services are a familiar offering to most people, so it would not be a hard process to leverage the existing services and sell "consults".
It is a simple marketing exercise.
Unlike the nurse consult exercise offered in isolation, the pharmacy service would be surrounded and nurtured by familiar staff in familiar surroundings.
(iii) Before any clinical consult venture is offered, research into the type of service, its cost and the marketing support required to educate patients to adopt the service, would be undertaken.
From known experience of developing such a service, it will take a full 12 months before there would be a sufficient patient base to support one practitioner.
It is a slow development.
(iv) During development, pharmacist practitioners would seek to cooperate with GP's to see if there were any true joint initiatives that could be developed.
Typically, GP's have spurned collaboration, but those that do collaborate would be delighted to find that patients would develop confidence in both sides of the operation, and success would be assured.
GP's perhaps don't generally realise that there is already ample evidence that shows cooperation between pharmacists and GP's creates a high level of patient satisfaction.
Without the bickering and aspersions cast, patients tend to flourish in such a shared environment.
Far from losing business, GP practices and pharmacies show good growth and the professional interaction benefits both sides.
(v) Diagnostic services would not remain the exclusive preserve of the GP.
Already there are a range of sensors and devices that can measure patient biometrics quite inexpensively. Some are described in this issue of i2P (see article Share an Innovative Future Direction).

And in any case, pharmacist practitioners would lobby for Medicare access to pathology services if genuine need is demonstrated.
Fighting against the tide might delay the access, but it will not ultimately prevent it.
With the advent of sophisticated electronic monitoring systems, diagnostic laboratories may not be even needed.

(vi) It is accepted that at the point of the survey some patients may have felt that pharmacists may not be able to match GP's in all area. This is understandable, given that pharmacist consults to date have generally been "invisible" to the general public.
In terms of patient sensitivity pharmacists are quite capable of generating the trust and privacy needed to have these types of conversations.
When pharmacy consults become "visible", I for one am looking forward to being an active participant in the exercise.

(vii) Independent prescribing is now only a matter of time for pharmacists.
Their UK counterparts have already successfully delivered in this regard.
The reservations expressed in the above survey would be valid today - but not necessarily tomorrow.
Pharmacists would view the provision of additional, but very basic services, as a means of filling major gaps that currently exist, and through competition, would reduce costs to individual patients.

(viii) Trust was a major element highlighted in the survey, with the surveyed group indicating more trust is given to GP's than to pharmacists.
This seems to be in conflict with the various polls that occur here in Australia for trust, ethics and honesty.
Pharmacists have long outscored GP's and the most recent poll in 2012 illustrates that the margin has widened between pharmacists and GP's (in pharmacist's favour).
It is felt that with properly resourced clinical services, the margin would widen still further in favour of pharmacists.
(Roy Morgan Poll for Professions 2012 - "Other professions that also gained high ratings for ethics and honesty in 2012, including Pharmacists (88%, up 1%), Doctors (83%, down 4%), School Teachers (76%, unchanged), Dentists (75%, down 1%), Engineers (70%, down 1%), High Court Judges (70%, down 5%), State Supreme Court Judges (69%, down 6%) and Police (69%, unchanged). Police were very highly rated in South Australia (84%), but rated lowly in Victoria (64%), West Australia (58%) and Tasmania (53%)".

I would suggest that rather than fight GP's on every level, all areas of collaboration should be explored.
Harmonious development for both sides is better than a discordant version.
I'm all for a peaceful life.

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