s We can’t answer until we are asked | 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

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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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We can’t answer until we are asked

Pat Gallagher

articles by this author...

Patrick Gallagher is well known in Information Technology circles. He has a vital interest in e-health, particularly in the area of shared records and e-prescriptions, also supply chain issues. He maintains a very clear vision of what ought to be, but he and many others in the IT field, are frustrated by government agencies full of experts who have never actually worked in a professional health setting. So we see ongoing wastage, astronomical spends and "top down" systems that are never going to work. Patrick needs to be listened to.

Oh gosh.
The editor has been asking me for sometime now to pen an article about my ICT related subject - as in the news, views and visions.
I have steadfastly remained silent for months.
My negative response has been solely based on one strong human feeling; that being the one of apathy.
A ‘why bother’ state of mind.
Why bother talking ad nauseam about things that spin around uselessly in political circles.
Why bother getting uptight about things that never seem to offer any hope of real change.
Why bother indeed.

The WOFTAM1 mind set rules – OK!

Then, as often happens, stuff suddenly comes from nowhere and you think to yourself –‘ah maybe there is still a glimmer of hope, just over the horizon”.
Stupid of me and I know it.
Hope flickers eternally though.
What has happened?

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Then, as often happens, stuff suddenly comes from nowhere and you think to yourself –‘ah maybe there is still a glimmer of hope, just over the horizon”.

Stupid of me and I know it. Hope flickers eternally though.

What has happened?

Firstly we had the Prime Minster announce last week the latest, new, all better, all spinning, amended Health Reform package. My reader out there might just recall I wrote an article at the time, last year, when the previous Prime Minister chap, whatsisname, announced the reform to end all reforms. Remember?

States to give up 30% of the GST, the Feds would take over 60% of the funding and she’ll all be apples.

So I wrote a piece for this newsletter and I have extracted these three short sentences from the five pages, 1600 word article:

“Health reform it aren’t. Pretending to reform hospital funding it is”; and

“My prediction (is) that this Health Funding Reform will all end badly”

Well it never actually started. So we can just say it failed to proceed and now we will steer the ship towards another iceberg instead.
Relax, situation normal.
All screwed up and after all, it is just monopoly money.

While it makes the blood boil just writing this, I will refrain from the hyperbole of quoting the $billions this present government has wasted of our money. It is ours and it seems they will continue to pretend it is theirs, to keep on justifying the trappings of power.

That bilious thought didn’t prompt me to write this piece however.

Coincidentally, also just this past week, across my desk came an explosive report and summary from the UK[2] - called ‘Ugly baby’. A poll of 1300 clinicians and workers in NHS hospitals on the subject of politically led change in Britain’s health space. It is dynamite and it is also sad, for many reasons, including the feeling of impotence and disengagement between the top-down and the bottom up audiences.

Anyway, I thought what would happen if we polled Australian hospital workers and asked them to express a thing or two about their sorry lot.

Questions seeking their views on National and State level leadership (cough, splutter, giggle, gasp); their views on how our money is being spent; their views on the daily miracles we see where they deliver world’s best health care, despite all of the governing idiots doing their best to hinder them; what do they know about e-health; about PCEHR; what is a HI; do they prefer HL7 or CDA; why are the two largest State based e-health projects ‘not progressing’; is your PAS better than my PAS; what is Casemix and are you ready for it, and so on and so forth.

It literally would be setting off a nuclear bomb under the present cohort of those responsible for the scandalous and irresponsible situation we find ourselves in.

Let’s do it I’m thinking.

Let’s ask the coal face workforce whether the intention to spend $466 million on nominated e-health projects is the right thing to do. Trouble is the coal face has little knowledge of what is planned (sic).

Be hard for them to answer, in an informed manner, in any sense without first knowing what the secret sauce recipe is all about.

What is needed is a step back to where the workforce is taken into the secret model of communications and be made aware of the whys, the how, and the wherefores - that very few of us have a clue about.

So, while I am cogitating all of this, along comes the next eerily coincidental  piece of data that essentially made me feel that some ‘thing’ is sending a message and damn it I should now answer (the editor’s call) and say something

I was sent extracts from a survey seeking the sort of answers mentioned above. How amazing! Just think about ‘it’ and ‘it’ will happen!

For proprietary reasons and fairness I can’t quote verbatim from the material.

What I can do is disguise and amend the actual questions and not identify the audience and their exact answers. Rather to just paraphrase and express broad generalities. Just enough to give you the startling sense of hilarity or gloom as to where we are being ‘led’ as $466 million of our money is sprinkled over tulips in some far, far off land of fantasy

The information jumps off the page and smacks you right in the face – and I am not kidding. Here goes:

* It is an association asking the questions[3];

* They engaged a expert pollster (who obviously are very professional and know their stuff);

* They polled GPs and Pharmacists within a geographical boundary; and

* Asked these sort of questions, and got these sort of powerful answers

1       Asked did they know about current programs covering PCEHR (if YOU DON”T KNOW, I’m not going to tell you) and the electronic transmission of prescriptions.

2       About interoperability and standards

3       Did they  know there is a budget of $466 million for these projects and are you ready for these programs in your practice

4       Is their installed IT systems ‘Standards compliant’

5       If not, will you change your IT systems

GPs answered as follows: Q1 – 45% had heard something, 45% had no idea and the rest didn’t reply. Q2 – 52% understood the importance, 30% did not respond. Q3 – 94% had no plans for these e-health programs. Q4 – 60% were either 'don’t know' or no response. Q5 (the lulu) 94% were a no response

Your peers answered thus: Q1 – much better, as 62% said they had heard something. Q2 – Same up to date 62% said they were aware. Q3 – On the other hand a whopping 73% of your peers had no plans for any of this INCLUDING e-prescriptions. Q4 – 62% were unsure. Q5 - like the Docs, 96% did not answer the question

What sort of $466 million don’t they understand? Rhetorical question, of course, because no one has really been told much at all except the few people ‘in the know’

Okay, okay, there are lies and statistics and this was a tiny sample (about 30 of each group= 60 all up) but I ask you to answer just to yourself, the question below. And I have asked the editor to consider asking these questions in an in-house, online poll, as well:

Are you up to date on the plans to spend $466 million on PCEHR and paperless prescriptions?

Are you full bottle on whether your systems will talk to other clinical systems (interoperability)?

Are you planning to be ready for these projects?

Are your IT systems, standards complaint?

If not, will you invest in IT system hardware and software changes?

A sobering wake-up moment and alarm bell ringing experience I would have thought?

I had an interesting experience recently where by chance I asked a GP these sort of questions – primarily had he heard of the plans for PCEHR and e-scripts.

No he hadn’t and to his knowledge nor had any of his colleagues. He wasn’t at all supportive of the PCEHR idea – positively anti the concept in fact.

Unfortunately he also had no time for the e-script plot.

On the other hand he was very animated when talking about what he would like to see happen – referrals and discharge summaries notably.

So this raises another question – has anyone asked the clinicians - “what is it that they actually want; when do they want it in a priority sense; and how do they want it to work”

Comedian, I’m not. So there is no need for me to answer the question.

Except to say that very few people, in a critical mass sense, knows "anyfink at all Guv. Nuttin!”

Not only is this true of you the Pharmacist, and the local GPs, it is also true, in the context of PCEHR and paperless scripts, that the great unwashed know next to zip.

Has any patient/client/customer ever asked you about PCEHR? Or, asked ‘when will e-scripts work”?

Any sales and marketing person will insist that you can’t deliver shiny new toys and services to clients who have absolutely no idea what you are trying to sell them. If the public do not know, how can there be demand. If there is no demand, why are you going to listen, invest and act?

Sounds too silly to be true huh?

Nope. That is where we are. The mushroom analogy comes screamingly to mind.

So perhaps some governor or other leader might consider polling the punters, via you possibly, as to whether they want to use a PCEHR and would like to have their scripts processed electronically? Could be as simple as asking each person, as they collect a script, would they take a second to answer a few questions by ticking a box and putting the slip in a container to be collated later by some agency.

Seems sensible? Doesn’t sound too stupid does it?

Do you think it will happen?

Not on ya nelly.

So. If that’s the case maybe we should look to start a groundswell of action by agitating upwards to the associations, to whom you pay a membership fee, to poll you and your peers?

It would cost a piddling amount of dollars (Survey Monkey is free) and would be the start of one hell of a sea change towards our (not) understanding of how our money is spent, where it is spent, on whom it is spent and why

Just a noddy question really.


[1]
                [1]  Waste of flaming time and money

 

[2]
                [2]   Published by a NHS Manager’s Blog

 

[3]
                [3]  In my view every medical association  in Australia should follow this brilliant lead example

 

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