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Pharma-goss - With Rollo Manning
* The QUMAX Aboriginal health program
* Fewer PBS scripts
* Doctor direct stirs the pot
* PBS supplies and the “continuum of care from hospital to community”
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The QUMAX Aboriginal health program
It is hard to know exactly what is in this program as the media release does say that
“The Guild successfully entered into a funding agreement with the Australian Government on December 2007 to commence work on the development and implementation of the Program.” This is almost as if it is not there yet.
Considering the QUM initiative between the Guild and NACCHO has been coming for six years this is not a real surprise and if the detail is not yet worked out it is suggested to the Guild/NACCHO combine that the $10.9 million be spent on employing pharmacists to work in Aboriginal Health Services.
This writer has been saying that the best way to improve QUM in a health service that has had nothing is to put a pharmacist in there and changes will soon happen.
Add to this the fact that every AHS is different and fiercely autonomous meaning that a one size fits all approach will simply not work.
Any manual, training program, list of subjects for education lessons to clients and health workers is best done from the local level.
Please – do not put in another set of guidelines, protocols, mission statements and work plans. These things only cost money to produce, is time consuming and are purely of academic interest in the end. Put a pharmacist in and it should happen – bingo – instant QUM.
Believe it!!
There is $10.9 million over the “life” of the 4CPA. And don’t you love that – again – the life of the 4CPA. Well its life started in July 2005 and is already more than half way gone – so who’s life are we talking about – the life of the QUMAX program – which appears to be still to start – or the 4CPA. Confusing?
$10.9 million and 130 health services, say 100 health services because some are small – that is $100,000 for 100 pharmacists to work in the AHSs. A great outcome could be obtained over the remainder of the 4CPA and an evaluation done to properly plan the future based on this experience.
This column is not against the plan as outlined as anything is better than the nothing that has been there up until now. But just get in there and provide the expert – some do not know what a pharmacist does except put labels on boxes. They will soon learn.
The least amount of bureaucracy that is established the more money there will be to spend on the health service. The early signs of this happening are not favorable as already there is mention of the following:
- Service-level QUM work plans
- A QUMAX Pharmacy Readiness Kit
- QUMAX Program Manager – Guild
- QUMAX Program Manager - NACCHO
- Local QUM support pharmacist
- A Program Reference Group
- Program Evaluator
That must be $0.5 million gone already!
There are times when Nike got it right – Just do it!
Fewer PBS scripts
The patient contribution increases and so the number of ‘PBS” prescriptions declines as there are fewer scripts to claim on the PBS through Medicare Australia. It would thus be expected that this will happen every year as the patient contribution continues to rise.
The reason for this increase is unclear but conveniently for pharmacists the more the patient contribution rises the more scripts can be priced above the previously gained 10% plus dispensing fee.
It is therefore surprising to read that the Pharmacy Guild is claiming some sort of victory each year with the “savings” on the PBS due to decreased volumes. Yes – decrease in the number of claimable scripts – sure – but what about the so called non-PBS which no longer attracts a government subsidy with all the cost paid by the consumer.
Quotes such as the following
“Based on data for the first eight months of the current financial year, there will be approximately 22 million fewer prescriptions in the system in 2007-08 than was predicted in the Guild Government Community Pharmacy Agreement, creating a saving of around $700 million for this year alone.”
…need to be qualified with the explanation of the increase cost to consumer.
Doctor direct stirs the pot
The consequence of the increased patient contribution (see story above) is that the consumer is becoming less reliant of the PBS for meeting the cost of PBS listed medicines.
With $10 of the cost taken up in fees this means that organisations such as Dr Direct
http://www.drdirect.com.au/index.html
are able to supply medicines legally and with a far less cost than at the local PBS approved pharmacy.
The value and volume in this sector of the market is not known, a situation that brought a strong rebuke from the Chair of the Pharmaceutical Benefits Advisory Committee at the PAC Conference in Melbourne last August.
Professor Lloyd Sansom had this to say:
''We [PBAC] can't even get from this profession the under co-payment data. My blood pressure soars every time I make that statement. That's an indictment on this profession, a damn indictment. What it shows is this profession is not taking seriously its contribution to health care outcomes. I hold the Guild accountable."
And so it goes on with the Guild now using data to come up with an innovative program for assisting adherence through a points system. Maybe Doctor Direct will take this up also.
Seriously – this is a big market – probably as big as the PBS costs to government over again. It should not be treated lightly and is the one making competition possible as evidenced by full page ads for Chemist Warehouse that appears in the metropolitan dailies.
Back in the old days of $5 patient contribution everyone was reliant on the Government coffers for the balance of the cost.
Think again when the patient contribution goes up again and ask whether the Approved Pharmacy is losing its grip of importance on the PBS supply arrangements. A “Pharmacy” can dispense medicine while an “Approved Pharmacy” can claim costs back from the Government. There is a difference but it is getting less.
PBS supplies and the “continuum of care from hospital to community”
An advertisement on the weekend for a position in hospital pharmacy reminded this column of the rhetoric of eight years ago about PBS meds being dispensed from hospitals to discharged patients and the protocol for a continuum of care from hospital to community were all the talk and a significant priority put on the activity.
It takes a while doesn’t it? Is it pharmacy, the world or just a slowness to initiate change in a health system that grinds along in the same old way until there is a disaster?
That’s all for now ….
Comments please on any subjects in this column or suggestions for topics that “Pharma-goss” could address
Rollom@iinet.net.au
Visit my website at
http://www.rollomanning.com/site/home.htm
For a more complete array of recent speeches, presentations and articles.
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