I suppose it is stating the obvious.
The doctor groups want to see most medicines confined to Schedule 4 of the Poison's Schedules.
The Australian Self Medication Industry would like to see medicines rapidly down-scheduled to the level where they can be marketed through high volume outlets such as discount pharmacies and supermarkets (also allowing direct-to-consumer advertising by manufacturers).
Well philosophically they would like more medicines in Schedule 3 but have not developed a proper system to handle the process, because their current models of pharmacy do not allow for sufficient pharmacists to be involved in the counseling process, and the discount pharmacies cut the prices to the extent that all but “lip service” counseling is affordable for the patient.
And at that point, professional associations become critical of pharmacy practitioners, but are unable to provide solutions, giving manufacturers and others, a chance to deflect the problem and paint pharmacists as “villains” with Choice (as a consumer association) cheering from the sidelines.
It also underscores an unrecognised opportunity for pharmacy to develop a unified solution to the continuing problem of a minority segment of the population wishing to continually harm themselves in some way.
All the above reflects, on balance, the “commoditisation” of medicines that is moving ahead at an accelerated pace.
Professor of Pharmacy Practice at the University of Sydney, Charlie Benrimoj, recently voiced his concerns stating that introducing medicines in grocery-type environments has both social and safety implications. Making medicines available in supermarkets may delay a patient from obtaining timely health advice, coupled with the further devaluing of pharmacy services.
Even when pharmacists sell medicines at lower prices, it is thought that this is just educating patients to shop the cheapest channel – pharmacy or supermarket, and in the long haul, only supermarkets can win that battle.
Changes to the PBS encouraging patients to switch to generic drugs based on price, further encourages this trend.
So how is this mess to be resolved from a pharmacist's perspective?
Supermarkets appear to have no duty of care in respect of the sale of medicines, and that is reflected in their retail price structure. They deal with “customers” and the “customer is always right”.
Drugs or packets of cheese...they are one and the same to supermarkets – only shareholders count.
Pharmacists deal with patients and customers, and while the customer may still be “right” when dealing with commodities, they are “not necessarily right” when they become patients dealing with medicines, and with the protection of the law, become further entitled to a “duty of care” similar to all other health professions.
At what point does a pharmacy customer become a patient?
And that seems fairly obvious – when they require the professional input from a pharmacists in respect of professional advice concerning medicines and health, and in the dispensing of scheduled drugs.
In fact the formal acknowledgement of a person becoming a pharmacy patient should be the preparation of a “patient profile”.
If we accept that argument, then we also have to accept that there is not a need for S2 medications – they should all be classified S3.
But all this is too expensive you say?
Well technology is moving ahead to the extent that through the use of a combination of smart cards, product bar codes and RFID read/write tags there is a convergence of technologies that makes the establishment of patient profiles and the recording of product sales, and formal information provided, a fairly simple process.
Perhaps this type of practice improvement, coupled with forward pharmacists, could overcome most of the associated cost problems.
Governments have looked at this technology, with the previous government moving towards an Access Card using smart card technology.
The incoming Labour government has canned this idea from a philosophical standpoint, but this does not preclude pharmacists becoming involved through negotiation with their patients.
Patients respond to increased pharmacist access very positively.
They see a personalised approach as a big plus in their choice of a pharmacist, and when that happens, recommendation sales begin to increase.
This increase in profitability would offset any negatives in respect of cost.
Smart cards can also replace other systems such as Asthma Cards, creating a further cost saving through the elimination of a manual process. The profile fee already established for this service can be duplicated across the entire S3 range i.e. a fee for establishing the initial profile, but competitive prices for the products sold, and maybe this should be made mandatory by regulators, with a fee structure incorporated.
A clear differentiation of services and how they directly benefit a patient will overcome any perceived price inequities from being established in a patient's mind.
So where should the practice support from pharmacy organisations be directed.
Well, ensuring a more balanced representation on the NDPSC scheduling committee would be a start.
Pharmacists are woefully under-represented in a process that is their lifeblood.
They could also encourage developers of pharmacy technology to be more friendly towards front-of-pharmacy activities, such as counseling and the sale of S2/S3 medications.
They could even be more encouraging in respect of private labels, whether purchased from a manufacturer or compounded in the pharmacy.
The processes to create compliance, but at the same time allow for individuality, would be a happy mix in this currently unhappy environment.
But the big issue for community pharmacists is to have active representation when somebody exploits the system e.g. as in abuse of Nurofen Plus ingestion.
The official knee jerk reaction is often a call to ban the product or introduce new recording requirements for pharmacists.
Why should pharmacists be responsible for monitoring the behaviour of this minority group?
Some pharmacists have been left exposed e.g. as in the Choice survey of Xenical counseling at the point of purchase, and have been condemned at all levels within the profession.
Given that the compliance problem may be more managerial than a deliberate attempt to avoid professional responsibilities, a problem-solving approach might prove a more practical solution.
And because it involves the entire Pharma community, why not a joint Pharma solution (including the regulators) rather than isolating individual pharmacists and crucifying them.