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From the desk of the editor - Introducing current ideas, perspectives and issues, to the profession of pharmacy
Issue 56: December 2006
Welcome to the December 2006 edition of i2P.
What a turbulent year it has been in terms of major change, with more still to come.
I cannot recall the profession of pharmacy having to endure such strident criticism from so many external groups ranging from consumer groups (Choice), professional groups representing medicine and nutrition, other retailer groups and government.
Of course, some of the crticism is politically inspired and becomes a cover for another agenda, but because the volume is getting louder, pharmacists and their governing bodies must take heed and address any obvious flaws in the practice of pharmacy.
To the above list you would need to add i2P writers, who have consistently warned of the problems not being addressed by pharmacy leaders.
The chickens are coming home to roost well and truly.
Peter Waterman - The Latest from the Pharmaceutical Society of Australia
PSA News - the latest from the Pharmaceutical Society of Australia.
Keep in touch with activities of the Pharmaceutical Society of Australia and their professional support for Australian pharmacists.
* 2007 PSA National Executive
NAPSA National Congress: Melbourne, January 2007
Global Health News from the Internet - Pharmacy Related Links
This section of i2P aims to keep readers informed of global news that may affect pharmacy.
Readers are encouraged to share links to items of interest, by simply e-mailing the story link to the editor through the "Contact Us" panel located on the home page.
Topics can range from drug-related news, Information Technology, medical communications, medical research breakthroughs, management and marketing issues.
Because this news area is dynamic and changes daily, readers should immediately bookmark any links that they find interesting.
Response to any item is also encouraged through the "Letters (Your Say) " column.
Rollo Manning - A Regular Column Reporting the News Behind the News
Pharmagoss - By Rollo Manning
* Choice Expose PBS Pricing Competition
* Give Aboriginal health a look for future opportunity
* The year that was….
NAPSA Congress, Coles-Myer take over Pharmacy Direct , Fourth Community Pharmacy Agreement, Section 100 arrangements for Aboriginal people, Robotic dispensing machines, The battle going on between the Pharmacy Guild and the entrepreneurs, Acceptance of the principle of “clinical pharmacies”
* Quote of the Month
Neil Johnston - Management Consultant Perspective
There is nobody who has a clear idea of what the future holds for pharmacy.
Nonetheless, there are some very clear lessons that have been learned to this point, and there are many pathways that can be trodden before the advent of 2010 – a potential date for deregulation.
Community pharmacy has lost its way and has to go back to its “roots” to reinvent its guidance system and create policies to successfully prosper in a full or semi-deregulated environment.
There is no reason why this cannot be done.
Pharmacy is a big business that has been held together by a system of laws and regulations that have legally protected its marketplace from full competitive forces.
The folly of this policy must have surely pierced the consciousness of all pharmacists by now, but how does one reverse pharmacy thinking into an open and completely competitive model, full of confidence and gearing up to meet the challenges ahead?
Well, for starters, stop worrying and start planning, and plan for an increased market share.
Grab the steering wheel with both hands and simply take charge!
Con Berbatis - A Pharmacy Researcher Perspective
Editor’s note : PoCT (Point of Care Testing) holds promise for the convenient and cost-efficient clinical testing of patients in their homes or by health workers including doctors and pharmacists in their premises .
The following report by Con Berbatis summarises Australia’s largest trial of PoCT in General Practice which will be completed in 2007.
By March 2006 a total of 5,166 subjects had been enrolled.
The design of the trial could be replicated for testing PoCT in community pharmacies.
Stuart Adams B.App.Sc (Nutrition and Food) - From a Nutritional Activist Perspective
With complementary and alternate medicines assuming some prominence in a pharmacy's inventory mix, and more recently, nutritional knowledge requirements for the various weight management programs emerging from pharmacy environments, there are concerns that some of the products and nutritional information provided to patients, may not be evidence-based.
Pharmacists have a responsibility to ensure that they practice to the level of standard mandated by their professional organisations.
Criticism has emerged from some nutritional practitioners that pharmacists are not observing the principles of evidence-based medicine, and are developing the sale of nutritional products on the basis of commercial return, rather than for patient benefit.
In an effort to make these concerns known to pharmacists we asked Stuart Adams, a qualified nutritionist, to write for i2P on a regular basis.
Stuart is a well known media commentator, has worked in pharmacies and has growing concerns for some pharmacy endorsements of complementary and alternate medicines, and the way patient nutritional support is handled for programs such as weight management, (currently assuming prominence in a range of pharmacies).
Stuart is an active representative for his professional organisation and is involved in programs of nutritional education.
He is a welcome addition to i2P and we recommend that pharmacists take special note of what he has to impart.
A solid and professional process gives you a strong and informed foundation to fend off any critics for now and into the future.
Some pharmacists will need to change, and as a basic work practice, ask every manufacturer to support their product claims with written evidence before allowing the product to appear on pharmacy shelves .
Neil Retallick - A Friendly Society Perspective
There has been a lot of press in recent weeks about the decision by Wal-Mart in the USA to offer a range of 314 different generic drugs for a flat fee of $4 for a month’s supply at commonly prescribed dosages.
The list includes 14 of the top 20 prescribed medications in the USA.
The initial program was rolled out on September 21 with great fanfare in one State only, Florida.
The plan then was to test the program through till January 2007 and then expand to other States throughout 2007.
However, the overwhelming customer response precipitated a State-wide roll-out from October 6th.
On October 19th, Wal-Mart announced it was extending the program into 14 more States – some 1,499 Wal-Mart pharmacies in all.
By October 26th, the program was in 26 States.
Karalyn Huxhagen - A Queensland PSA Councilor Perspective
I have always been an avid follower of the pharmaceutical care model of pharmacy practice and I was very interested in the new handbook released by the Department of Medicines Policy and Standards at the World Health Organisation this week.
The handbook is titled “Developing Pharmacy Practice a focus on patient care-2006 edition”.
The handbook moves through many discussions, learning objectives and case studies looking at the development of Pharmacy Practice. Underpinning the basis of the handbook is the discussion of the seven star pharmacist. The authors discuss the roles of integration, referral and the importance of the patient’s ability to be an active team player in their health management.
Anthony Tassone - A Pharmacy Manager Perspective
With the recent announcement of Generic Pricing Reform in the PBS – and the stir it has created, one can easily forget the too-ing and fro-ing that occurred between the Pharmacy Guild and Federal Government concerning finalising Location Rules for Pharmacy during the Fourth Agreement.
At the time, it was seen as a ‘win’ for Community Pharmacy.
Location rules prohibited pharmacies from being located within or directly accessible to a supermarket.
Many other pre-existing rules were maintained with some slight modifications to entice competition between pharmacies – but overall the Community Pharmacy profession didn’t feel it had much to complain about.
Chris Wright - Dispensary Systems Perspective
I’m naive enough to think that community pharmacy will thrive post deregulation if proprietors take the necessary steps now to ensure the survival of their business in a changed environment.The exploits of the ubiquitous Mrs Wright have appeared on these pages before. However, her last little exercise that spanned no less than three Pharmacies is worth reporting on, if only to simply demonstrate that there is much to be done if proprietor Pharmacists’ are to protect themselves commercially, both now, and particularly in the future when it is becoming apparent that less models will be in evidence.
Robert Forsythe - Globetrotting Community Pharmacist Perspective
Its that time of year again to reflect on what has happened over the last 12 months and where we are going for the year ahead.
I had to submit an article this month.
I2P writers fear Neil Johnston (i2P Editor) in the way 1980's pop singers feared Bob Geldoff.
During 2007 I have made the step of moving back into hospital pharmacy.
This was prompted by a stark realisation (with a little help from my accountant) that the business which I was about to part purchase wasn’t the ‘little goldmine’ everyone thought it was.
Lots of volume - limited profits.
I also have a young family and as a Generation X’er was finding the hours of community pharmacy a bit tedious.
Not the official ones but the 7pm and unpaid weekend hassles nursing home nonsense.
Ken Stafford - A Consultant Pharmacist Perspective
2006 has been quite a year for me as a writer for the i2P newsletter – I think I’ve probably insulted most of the pharmacy organisations and their leaders at some time or other, especially if I’ve been having a “blah” sort of day when sitting down in front of my word processor.
Like most of the readers of this newsletter, I get very tired of the pressures being placed on community pharmacists, and some times it shows.
Pat Gallagher - An IT Consultant Perspective
Picking right up from last month’s observations regarding wholesaling (“And, then there was …two, one or none?”) woes and worries, I have since clipped around seven stories in the press on the same subject.
Where I used the ICT angle and the lack of information feedback, the popular press folk have used the PBS reform as the underlining driver in reaching pretty much the same conclusion.
In one national financial daily the following bite appeared – “…..taking a longer-term view, expects the PBS changes to drive consolidation in the pharmaceutical industry”.
At that point the writer was more or less describing the future of wholesaling, while later in the article the focus moved onto retail, community pharmacy, and (its) consolidation.
Well, that is to be expected surely?
If the big and the powerful are vulnerable to change, then it stands to some reason that the small and the powerless, collectively-you, will also feel the heat.
Is this fair?
Dr David More - From a Medical IT Perspective
The international research firm has recently released a report entitled Australian Hospital Information Systems Markets (Frost & Sullivan, March 2006).
The summary of the report makes some interesting points.
The first is that they see the key driver of increasing investments in Health IT as being driven by a growing demand for safer and improved healthcare noting there are ambitious plans underway in a number of states and at the Commonwealth level.
The second point they make is that there is a strategic shift in healthcare IT requirement that is expected to boost market growth.
They go on to say:
“Hospitals in Australia are replacing legacy systems with sophisticated and integrated ones. Similarly, there is a strategic shift from the adoption of administrative systems to clinical systems and healthcare providers of various states and territories are looking at integrating their IT systems under programs such as the nation-wide electronic health records. Australia is slowly moving toward an integrated healthcare delivery structure, where healthcare agencies will be linked with each other, notes the analyst of this research service. Information systems are expected to play a vital role in this structure and there is likely to be an increased uptake of hospital information systems to allow seamless integration between the legacy and contemporary healthcare information systems.”
Garry Boyd - From an Intellectual Capital Perspective
The Venetian Senate passed the first Patent Law in 1474. This Law embodied the principles of patent protection, as we know them today.This was some 53 years after the city-state of Florence granted what is recognised as the first patent.
Filippo Brunelleschi was granted a patent for the design and use of a ship, known as the Badalone.
The Badalone’s intended use was to ferry building materials up the river Arno to the city for the building of the Florentine Cathedral dome.
It could be said that the design of the patent was more successful than the design of the Badalone, as she sank with a load of white marble.
Dr Andrew Byrne & Associates - A Harm-Minimisation Research Perspective
Editor's Note:Dr Byrne (and his associates) advocate for better policies which are proven to reduce risks for drug users and the general community under a framework in parallel with Australia's official policy of harm minimization.
The findings of the New South Wales Drug Summit recommend better access to methadone, detoxification and other dependency treatments.
It also advised investigating alternative services such as supervised injecting centres, leading to the opening of the Sydney Medically Supervised Injecting Centre in 2001.
Dr Andrew Byrne has been involved in opioid treatments from a primary care background for 20 years at the same site in Redfern, an inner suburb of Sydney.
He is recognised worldwide as a specialist in the addiction field and was involved in the seminal stages of the Chapter of Addiction Medicine, Royal Australasian College of Physicians.
He received the Dole-Nyswander award from the American Association for the Treatment of Opioid Dependence in April 2006.
A range of publications on pertinent strategies for harm-minimisation is available for dowloading at: http://www.redfernclinic.com/publications/
These e-publications may prove to be of practical interest to those pharmacists interested in dependence and addiction .
This month we are pleased to publish a new conference report (APSAD Annual Scientific Conference. Cairns, Queensland) prepared by Dr Andrew Byrne.
Dr Richard Hallinan has also had an interest in addiction medicine for about 20 years.
Since joining the practice in 2000 he has published several key papers on subjects including hepatitis C and optimising methadone dose levels.
He also has performed studies on hormones, mood disorders and related matters in dependency patients.
Dr Hallinan also worked for years as a professional violinist in both Australia and in Austria.
Barry Urquhart - International Conference Keynote Speaker
Hobart, Tasmania is a magnificent water-oriented city at any time, particularly in the spring season of October.
The Royal Yacht Club of Tasmania created a sublime setting for a business development luncheon address for the existing and prospective clients of Radio HO-FM.
Alan Parsons, the Sales Manager, took a risk and challenged the invitees with a topic title of:-“12 Must Do Things for Tough Times”
The response was strong and immediate, with many business people appreciating the candour of the customised content.
According to Alan, some business owners had literally decided to “take their foot off the accelerator”, or, in other words, to suspend advertising expenditure and see what happened.
Drawing the parallel between yacht racing and the discipline of strategic and competitive planning, we were able to establish to the satisfaction of the attendees that taking one’s foot off the accelerator, or hand off the tiller if you will, is not an option.
The head winds of competition simply ensure that the yacht (read business) goes backwards.
Now more than at any time in the past 12 years the only two viable tacks (pardon the yachting parlance) are growth or profit.
Disciplined planning and execution of the plan will ensure momentum is achieved.
One fundamental issue is to ensure that “all crew members” have committed to the same goal.
Our unique strategic plan structure provided an opportunity for the attendees to determine some singularly important and timely initiatives.
As with the yachting simile, we are all subject to external forces over which we have little or no control.
Calling John Bertram!!
By a Staff Writer - Conferences and Events
This section of i2P is designed to be an experimental section to introduce other publications that have similarities to i2P, but are based in other countries.
The globalisation of Australian pharmacy started around the year 2000.
It has had minimal impact up to 2004, but that is now changing and i2P must reflect that change.
There are many aspects of globalisation not yet fully understood, but I think that to most of us, globalisation means that we must be quicker on our feet and have pharmacy practices with sufficient critical mass to withstand global pressures.
Depending on the model of pharmacy chosen, and its location, global pressures will vary.
As pharmacists we must begin to open up our minds to new ideas and innovative ways of delivering pharmacy practice.