s Primary Health Care and Pharmacy Clinical Services | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


From the desk of the editor

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

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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

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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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Primary Health Care and Pharmacy Clinical Services

Neil Johnston

articles by this author...

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

Editor’s Note:

Pharmacy leaders, academics and education providers have suddenly become alert and attentive to a paper recently released by the Grattan Institute.
Although I personally remain cynical as to where the recommendations within that paper (titled Access All Areas ) will take pharmacy, nonetheless it has created a spark of activity across an otherwise bleak landscape.

Governments have long squandered opportunities that have been available to them through the profession of pharmacy.
This has probably come about because of the top heavy list of advisers drawn from the medical profession over a long period of time.

Could this be a signal that policies may finally be changing to embrace the potential that pharmacists could be unleashed over the primary health care community.

I have asked Mark Coleman to comment on the following  Pharmacy News media report item that contains a response from both the PSA and the PGA.

Pharmacy response to Grattan report

1 October, 2013 Pharmacy News staff


Pharmacy News presents a round-up of comments from the PSA and the Pharmacy Guild of Australia in response to the Grattan Institute report, released late on Sunday. 

Pharmacists welcome report highlighting need to better utilise their skills and knowledge 

A report by the Grattan Institute which highlights the critical and immediate role that pharmacists can play in relieving rural doctor shortages has been welcomed by the Pharmaceutical Society of Australia.

The report, Access all areas: New solutions for GP shortages in rural Australia, authored by  Stephen Duckett and Peter Breadon, says the number of GP services per person in the lowest-access rural areas is less than half that of the major cities in Australia. 

“When people can’t see a GP, they get sick with conditions that could be prevented,” the report says.

It goes on to state: “By using pharmacists’ skills better, and by introducing physician assistants, the primary care gap in the lowest-access rural areas can be filled in only five years.”

Pharmaceutical Society of Australia 

More at this link

Community pharmacy ready to step up

The Guild welcomes the release today of the Grattan Institute’s report “Access all areas: new solutions for GP shortages in rural Australia.” It is the first report of its kind to acknowledge the need for an expanded professional role for community pharmacy as well as specifically stating a viable, cost effective remuneration model to accompany such new services.

A key proposition in the report, which we support wholeheartedly, is this: “The first step is to make much better use of pharmacists’ skills. Pharmacists are highly trained, have deep expertise in medicines, and are located in communities throughout Australia. But their role is far more limited in Australia than in many other countries.”

The report does not propose any new professional service for pharmacists that does not already exist in other jurisdictions across the world

The National President of the Pharmacy Guild, Kos Sclavos, said: “The Guild welcomes the proposal to establish MBS items for these new services as well as utilising the infrastructure of the existing community pharmacy network.”

The report highlights rural and regional deficiencies yet community pharmacy services are the most easily accessed of all health services in these regions. 

The Guild particularly welcomes the acknowledgement that pharmacists should play an expanded role in immunisation. Currently Australia is one of the few Western jurisdictions that does not have a program for pharmacists to play this role. The proposed professional reimbursement via the Medical Benefits Schedule (MBS) would ensure that not only is the service conducted in a professional environment with all the appropriate risk issues addressed but also such a paid fee would ensure that pharmacists record such information on the health record of the patient.

Importantly, the report addresses some of the traditional arguments used against such an expanded role for pharmacists. For example, the issue of conflict of interest with the pharmacist being both the prescriber and dispenser is addressed by the proposed expansion of the existing continued dispensing provisions, rather than proposing full independent pharmacist prescribing.

More at this link

Pharmacy Guild of Australia.

Mark Coleman

Well there certainly has been a range of comment generated from the publishing of the Grattan Report Access all Areas.
While the editor remains cautious about the motivation and direction of this report
( See Access all Areas - Is This a Positive for Pharmacy?)
he does so because of the previous unwarranted attacks that have been made on pharmacy from a number of quarters, going right back to the establishment of the PBS in 1952 where regulations were commonly formulated as “pharmacists will…” while “doctors may….”.

These derogatory forms of regulation have always existed and this simply represents the medical profession looking down from a lofty height on all health professions.
Education and understanding has improved across all health professions and with the explosion of health needs spread over our ageing population, most of us can see how to fill some level of those needs inexpensively and efficiently.

While i2P writers will still continue to highlight inequities, in the interest of professional unity and development we certainly support any positive or progressive movement.
Hopefully the Grattan Report will ultimately prove to be a positive, and with that being said, I know all the writers of i2P will give it the impetus it may need at appropriate times.

One quandary that has existed for some time is the fact that most new clinical services in community pharmacy will be delivered directly by non-pharmacy owners, mainly because the management of a pharmacy is now quite complex and time consuming and owners do not have the time.
So if pharmacy owners can play their part by delivering infrastructure support to clinical pharmacists (non-owners) it is possible to create an equitable division of interests through a fee-splitting approach, much like GP’s in a group practice who pay around 30% of their fees to provide practice management.

Pharmacies already do this in the sense that they delegate their marketing to franchisor providers. This frees up a lot of management time and the time required for research, and so becomes workable.

The Grattan Report has had an immediate positive in the alignment of consultant pharmacists.
The Society of Hospital Pharmacists of Australia has announced that two major players (Debbie Rigby and Peter Tenni) in the consultant pharmacist space have joined the SHPA consultant pharmacist reference group.
This is a positive provided it morphs into a group that can give positive direction for consultant and other clinical services.
Quoting Debbie Rigby:
 “Accredited pharmacists need a voice to influence the future direction and sustainability of medication reviews.
It is a critical time in the evolution of these services, to identify how consumers and GPs can achieve best value from HMRs and RMMRs. The purpose of this group within SHPA is to support and advocate for members in a collaborative fashion with all stakeholders. In addition, I believe SHPA membership has many benefits for accredited pharmacists, with high quality relevant education, access to full text journals, online CPD recording and other resources.”

And Peter Tenni, one of the largest Australian providers of HMR’s, said:

SHPA provides a wide range of clinical resources and relevant online and face-to-face education programs. I expect that the formation of the Reference Group will result in an expansion of these services as well as development of new activities for the benefit of pharmacists. I encourage all consultant pharmacists to explore the option of joining SHPA as a way of supporting their practice.”

SHPA also provides education to the Professional Pharmacists Association which is an organised group of non-owner pharmacists providing industrial services.

I congratulate Debbie and Peter in stepping in to provide leadership, and all i2P writers send their best wishes as well.

The potential alliances that can result from these linkages are such that I can confidently forecast that a “balancing up” can now occur internally within the profession that can temper some of the imbalances created by the Pharmacy Guild of Australia.
Let us hope that all of pharmacy can now look forward to a future where a united front will push back all those detractors from outside of our profession and we can all enjoy the profession that we all hold dearly.

The new alliance also holds out the possibility that pharmacist interns can get a good clinical grounding within the public hospital system and that “refresher options” can be made available for all pharmacists in a hospital setting.
This would at least balance of some of the disadvantages experienced with pharmacist training because of the lack of “hands on” experience with a range of complex patients.
But we also need to add to the curriculum the matters of differential diagnosis, independent prescribing and the giving of drugs parenterally, including vaccines.

Nurses are also seeking this type of training, including the distribution and sale of drugs.

If both nurses and pharmacists become qualified in those particular areas we could see pressure taken off in the shortage of GP’s, because that is artificially induced as GP’s  to convert to specialists as soon as they can, and practice in urban environments.
That is a waste of taxpayer health dollars.

It’s too early to get excited, but the lid that has held down pharmacy services development may be about to be lifted – even if only cautiously.

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