s Servants to the world. | I2P: Information to Pharmacists - Archive
Publication Date 01/11/2009         Volume. 1 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the November edition of i2P – Information to Pharmacists.
The month just finished has been an exceptionally busy one for pharmacy with an interesting PAC being concluded.
The “Great Debate” from PAC stirred considerable interest, also the talk given by John Menadue.
The latter has been reported and commented on in the article “Pharmacy’s Professional Future” and it is recommended that this article be bookmarked.
Better still, add your comment at the foot of the article.
All our columnists are back on deck and we are delighted to report that our New Zealand columnist, John Dunlop, has been accorded high honours by the New Zealand Pharmaceutical Society.
See the article in the Recent News section or look for the editor’s logo in the column section.
Our congratulations go out to John for this honour that resulted from his work in the pharmacy professional services area..

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Recent Comments

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Pharmacy’s Future Professional Services

Neil Johnston

The recent “Great Debate” at the 2009 Pharmacy Australia Congress had an excellent topic choice (“The answer to our future is increasing front of shop sales, not professional services”).
The answer is, of course, that pharmacies need both activities as “core business” to survive – it just depends on what balance is required for each unique pharmacy practice sufficient to allow for differentiation and emphasis on specialties (whether professional services or retail activities).
However, it could be argued that policies in recent years have tipped the balance in favour of supply services that favour retail activity.
Little research or effort has gone into the development of professional services (there is actually major amounts of unspent grant money from the Fourth Agreement), so many pharmacies see little relevance in promoting services they may not have the training for, or the infrastructure to deliver the necessary training (which comes at a cost).

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Servants to the world.

Ken Stafford

Recently I received a number of calls from a concerned relative of one of our veteran clients currently in an aged care facility.
The problems I am hearing about relate to the difficulty in getting the patient’s doctor to write prescriptions for necessary medications, echoing many of the stories I heard during my pharmacy visits about the problem of “owing scripts” and just how hard it is for pharmacists to get them written. If we break down the problem we get this sequence of events:

Comments: 2

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Communicate anywhere and everywhere – is getting nowhere

Pat Gallagher

Is talking about talk the best way to start solving the sharing of data in a health informatics scenario?

I have often written on the subject off interoperability; referring to broken and failed systems and in the attempts to get everyone in healthcare, primarily inside a hospital, to exchange information without re-working it all the time.

This can be a complex subject matter because it has little to do with technology and all to do with people. If various departments and fiefdoms want to share their data it can happen; if they behave in a recalcitrant manner, it won’t happen.

Which takes us down a path, for perhaps another time, regarding the subject of IT systems and collaboration? We Australians are not good at this – there is something in our makeup that resists sharing certain things, notably information management systems. Not sure whether it is a streak of independence or immaturity, or both. Anyway, moving on to the matters at hand, let’s continue.

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Power in Numbers rises up the charts in Pharmacy.

Chris Wright

There is power in numbers.

It is said that Chemist Warehouse is growing at 25/30% per annum, the traditional franchises are growing at about half that rate and the poor old unbranded Pharmacy is trailing behind at about 10%. This really means that Chemist Warehouse is flying along with a wet sail doing nicely and all others are wondering where to find growth or are spending far too much time with their accountants’ trying to work out how to survive the future.
This is no surprise of course; the Chemist Warehouse business model is brilliant, they are compelling marketeers and proof that the power in numbers prevails.

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It's all in the Genes

Staff Writer

When you think about it, genetics are likely to determine your skin type.
It is little wonder that if one or more of your relatives, including your ancestors, had a predisposition to skin cancer, then you may have inherited that trait.
Researchers believe that there is up to a 50 percent risk involved that you will develop skin cancer through genetic inheritance.

Skin cancer can be inherited: studies

Source: Reuters
http://www.reuters.com/article/healthNews/idUSTRE5984VM20091010?feedType=RSS&feedName=healthNews

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Why New Zealand must rapidly halve its greenhouse gas emissions

Staff Writer

Editor: It is good to see the New Zealand medical professionals getting behind climate change strategies in their country.
Pharmacy, particularly here in Australia is conspicuous by its absence in this activity.
Yet there are many things we can influence - particularly in the areas of the supply chain, shop design and the type of fixtures and fittings we select.
Unless we all begin to be proactive in this area, events will pass us by to our detriment.
Add your comments at the foot of this article to start off a discussion.

Source: New Zealand Medical Journal
Article written by: Scott Metcalfe, Alistair Woodward, Alexandra Macmillan, et al; for the New Zealand Climate and Health group

http://www.nzma.org.nz/journal/abstract.php?id=3827

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The Pharmaceutical Society of New Zealand 2009 Honours

From the desk of the editor

In Issue number six of Pharmacy e-Edge, the newsletter of the Pharmaceutical Society of New Zealand, four New Zealand pharmacists were awarded a range of honours. The report was prepared by Richard Townley, the CEO of the Society. Among them was John Dunlop, our i2P writer representing New Zealand, and we are pleased to share in John's achievement. John was awarded a Fellow of the Pharmaceutical Society of New Zealand in recognition of his outstanding contribution to the advancement of the practice of pharmacy in New Zealand. Congratulations John!

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Brits love the NZ version - "Fush 'n Chups"

Staff Writer

In a press release by Dr Allan Bell of Auckland University of Technology (sure to raise eyebrows with some Australian i2P readers), it is stated that:

"The New Zealand accent has been rated the most attractive and prestigious non-British form of English, according to a BBC survey.
New Zealand English came in first ahead of Australian, American and most regional British accents in the study published in the international Journal of Sociolinguistics, edited by Professor Allan Bell, Director of AUT’s Institute of Culture, Discourse and Communication."

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Food as medicine - brown rice benefits diabetic patients

Staff Writer

Choosing your rice variety may provide an inexpensive support for a program to treat diabetes.
Menus involving varieties of brown rice may reduce glycation and the rate at which sugar is absorbed by the body.
Cinnamon is another food known to sensitise insulin and reduce sugar levels.
With a some thought it appears that a variety of foods that combat diabetes could be combined to create dishes that are not only functional, but delicious to eat as well.


Brown rice could aid diabetes control


By Anuradha Alahakoon

Source: SciDev.net

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The Starting Point

Neil Johnston

It was refreshing to read some positive recent announcements, comments and opinions in the media over the past three weeks.

First was the announcement by Nicola Roxon regarding the National Preventive Health Agency and the positioning by the Pharmaceutical Society of Australia firmly in support of this development of her initiative.
It is not quite 12 months ago that i2P ran a story on Nicola Roxon, her family and political background, at a time when she was relatively unknown in health circles.
Some observational and predictive points from that i2P article dated December 2008  -"Have you met Nicola Louise Roxon?" -are shown below.
Go to http://archive.i2p.com.au/?page=site/article&id=1168  for the full article.

"* Nicola appears to be a very normal and stable personality with strong family values, and is direct, straightforward and honest in her professional life.

* Nicola will endeavour to broaden the concept of health from illness treatment to illness prevention. She is well documented in many statements that “prevention is better than cure”.

* Pharmacy will be included within primary health care (something that other professions have tried to restrict), and the role pharmacy already plays in self-care will be recognised. I am sure that funds will be made available for the extension of self-care, work that has always been unpaid work performed by pharmacists.

* Nicola, however, needs to understand exactly what depth pharmacists have provided primary care, almost in a secretive fashion, because of constant harassment by doctors. While there is a surface cooperation between doctors and pharmacists, it is really only lip service.

The removal of this harassment would allow pharmacists to thrive as well as the general public.

* Nicola also needs to understand that while pharmacy owners provide infrastructure to provide medicine distribution, the pressure of this infrastructure works against the development of clinical services.

For this role she needs to recognise pharmacists individually as health practitioners and separate their income from the PBS model.

By providing incentives to individual pharmacist practitioners, development ideas and capital would flow in from these people and pharmacy owners would form beneficial relationships to harness benefit for the supply side of their businesses.

* From the recent address given at the Pharmacy Guild of Australia annual dinner, Nicola said, in part:

“The examples of existing Professional Programs and Services confirm the pharmacist’s role within the primary healthcare team.There may still be some debate about the borders of that role – but the direction is already well and truly established.

I want to be clear here – and I suspect my earlier comments have already given this away – any expanded role for pharmacists will take an incremental approach, and will be dictated by the need for safety and quality in health care.”

In other words, she will do what she has always done – carefully plan and test any program before it becomes policy.

It would seem that we were substantially correct and that the National Health Preventive Agency will offer a great opportunity for pharmacists to take advantage of their current training and skills set.

The second item was contained in a press release by the PSA dated 16/10/09 regarding a Memorandum of Understanding that was signed in Sydney by the President of the PSA, Warwick Plunkett, and the President of the RACGP, Dr Chris Mitchell, at a ceremony during the Pharmacy Australia Congress.

While details of the memorandum still have to be released, it may eventually mean that pharmacists will be able to practice independently and in alliance with GP's without the constant sniping that has been a feature of a relationship, which if worked cooperatively, has always been proven to provide maximum patient benefit. Good work PSA!

The third item of interest was an opinion article written by Geoff Marsh, president of APESMA.
Few comments have originated from APESMA, so it was good to see a comment from this organisation, as is really the voice of non-pharmacy owners, or to put it more succinctly, the logical representative of the pharmacists who provide professional services (whether or not they are paid up members).
The following appeared in Pharmacy e-News on 23/10/09 (located at
http://static.rbi.com.au/common/contentmanagement/pharmnews/PDFNOAD/20091023.pdf

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Servants to the world.

Ken Stafford

articles by this author...

A Consultant Pharmacist Perspective

Recently I received a number of calls from a concerned relative of one of our veteran clients currently in an aged care facility.
The problems I am hearing about relate to the difficulty in getting the patient’s doctor to write prescriptions for necessary medications, echoing many of the stories I heard during my pharmacy visits about the problem of “owing scripts” and just how hard it is for pharmacists to get them written. If we break down the problem we get this sequence of events:

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1. The residential aged care (RAC) facility patient has medications administered under instructions written in the medication chart.

2. The patient runs out of medication and has no further prescriptions/repeats on hand.

3. The facility staff order the drug from their contracted pharmacist who will usually dispense as an “owing script” ie dispensed under the understanding that the doctor will write a new prescription as soon as possible (the process is really only legal if this script is supplied within seven days.)

4. The doctor may write the script immediately or, as is more common, will take his own sweet time about it.

5. The pharmacist attempts again (and again, and again) to get the script until finally, often many weeks later, it arrives. Meanwhile the pharmacist is usually out of pocket as he cannot claim reimbursement from the PBS and is, strictly speaking, in breach of the regulations and law.

Sounds familiar doesn’t it?
You might wonder why any pharmacist is willing to put up with this stress or if any other professional group would do likewise.
My feeling is that this process is probably highlighting that pharmacists are everybody’s servant.
It appears nursing home staff seem quite happy to let pharmacists do their “dirty work” in relation to the patient’s medical care - provided they have the medicines they are happy and it doesn’t matter that they are expecting pharmacists to break the law. I have yet to hear of any nursing home demanding that a GP actually looks after their patients – much too hard and “we don’t want to upset the doctor”.
In the case that I mentioned earlier, when the caller tried to “encourage” the doctor to do the right thing by their relative the doctor threatened to stop looking after the patient’s medical care!
The nursing home staff wouldn’t help because this was the only doctor willing to look after their patients.
The pharmacist did everything he could for the patient even to the extent of losing the patient co-payment when Safety Net scripts supplied as owing in December were not written until well into the new year.

These stories remind me of my early days in BC (before computers) pharmacy when a doctor was supposed to write the patient’s pension number on the script, but usually didn’t.
Every pharmacy I worked in back then had a series of different coloured biros (to match those of the doctor) and most pharmacists became fairly proficient “forgers”, simply to meet the requirements of a legal script. I never heard of any government agency hounding doctors to have them “do the right thing”.
We can’t upset the medical profession.

The same problem occurs with Medicare Numbers on prescriptions – if the card number is incorrect or the card out of date it is the pharmacist that suffers, not the prescriber. ‘Why?”, I asked Medicare “because only the pharmacist is claiming payment for that script so it is up to him/her to ensure accurate information”.
Everybody’s servant???
I bet the doctor gets paid.

This requirement for pharmacists to make sure that all the clerical aspects of a PBS script are correct has always irritated me, as has the expectation by patients and nursing home staff that pharmacy will supply a medication under the owing script provisions to ensure continuity of care.
Why has continuity of care always been the (apparent) sole responsibility of the pharmacist in this rather than the prescribing doctor or nursing staff?
It seems that pharmacists the low men on the totem pole, acting like a doormat and allowing all others to walk over them.

In previous times I watched in frustration as pharmacy took the brunt of these problems with no real solution in sight.
Now there may be a way out of it– permit pharmacists to write PBS scripts with the same conditions as nurse practitioners and some other allied health professions.
I don’t advocate open slather, merely a process whereby pharmacists servicing nursing homes can, with the authorisation of the GP, write scripts based on the medication chart to cover supply of medicines. The same procedure could be applied to private hospitals and discharge scripts from public hospitals.
I am not advocating pharmacists become surrogate doctors, I’m simply suggesting that a fairly simple clerical process (writing a continuing treatment script) might become the province of selected pharmacists.
This could be restricted to specialists such as accredited consultant pharmacists.
Possibly not the complete answer to the owing script problem in nursing homes but this would go a long way to solving it.
I’m sure many of our colleagues will argue against this idea, giving a multitude of reasons why it wouldn’t work, but just imagine how great it would feel to be, even in so small a manner, masters of our own destiny and no longer servants to the world?

Return to home

Submitted by Neil Johnston on Tue, 17/11/2009 - 13:25.

In the case of nursing homes I think there is a very good case for so-called "medication continuance" by the pharmacist.
But not without a fee as has been suggested.
Here is a situation where an independent pharmacist could contract to visit a nursing home at predetermined intervals and arrange continuance without compromising patient safety or the breaking of any regulations.
This is not rocket science and could be performed by any registered pharmacist (not necessarily a consultant pharmacist, because the service may never take off, if bound down with top-end bureaucracy).
Because we are dealing here with patients in a controlled environment with the service required being the authorisation of one weeks supply of medication listed on a medication chart, there is minimal risk.
It's a job any new graduate is trained for and generates a potential income stream that could see an uptake of graduates.
The alternative is to lose them completely, and that would be a tragedy for Australian Pharmacy given the skills shortage that is going to occur over the next 30 years (in all professions).

Submitted by Terry Irvine on Tue, 03/11/2009 - 10:07.

Could it be that the doctors do not have a high priority to care for inmates of nursing homes? Maybe it would be better for prescriptions for nursing home patients to be automatically extended unless the doctor indicates otherwise.

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