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From the desk of the editor - Introducing current ideas, perspectives and issues, to the profession of pharmacy
Issue 61: June 2007
Welcome to the June edition of i2P.
It would seem that the enormity of changes occurring within community pharmacy are only just filtering through to the “coalface”.
With that realisation comes the next phase – mild panic!
And the self-doubt questions including “What will I do next?”
Rollo Manning - A Special Report on Indigenous Health from Northern Australia
Editor's Note: Most readers of i2P would know of Rollo Manning's passion for delivering better pharmacy services for indigenous people.
Few would realise the official obstacles that are put in his way, as he attempts to deliver those pharmacy services.
This often manifests in many disappointments and frustrations.
Whatever opinion you have formed of Rollo through his writing in i2P, none could but admire the dedication and compassion that he delivers to indigenous people during his normal working day.
Rollo is unique, often misunderstood, but always has a strong perspective on life, and indigenous health in particular.
i2P is very pleased to assist Rollo to deliver his message to pharmacists and hope that it strikes a chord with the majority of pharmacists.
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.
* PSA members vote for unity
* Fellowship boosts evidence-based pharmacy practice
* NAPSA ‘Wildcard’ to compete for Pharmacy Student of the Year title
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 comment on any news item by contacting the editor through the "Contact Us" panel located on the home page.
News items and topics displayed 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 will be published through the "Letters (Your Say) " column.
By a Staff Writer - Publications to Note
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.
By a Staff Writer - Conferences and Events
As part of our information service, i2P informs on Conferences, Workshops and Seminars or press releases that may be of interest to pharmacists. PSA event information will be found here, but PSA news will continue to be published separately in the section reserved for PSA press releases.
Pharmacy organisations may submit material for publication, preferably in digital format (Word document).
* NSW Pharmacy Expo 2007
* Pharmacy Australia Congress (PAC)
* Dynasties of China Tour - organised by Mike Lazarow in conjunction with the ACPP&M
* FIP Pharmaceutuical Sciences World Congress and the 67th Annual Congress (Beijing, China)
* The Pharmacy 2007 Conference - organised by the Friendly Societies, this conference has gone from strength to strength each year to become the premier pharmacy conference.
Don't be disappointed - book now to ensure your reservation in Hobart this year.
* New release - Therapeutic Guidelines Gastrointestinal 4 2006.
Order your copy to keep pace with current developments and guidelines.
Letters to the Editor - A Reader's Perspective
Your Say is the column reserved for subscriber (or other source) comment relating to i2P articles, or reportage or general comment on the profession and industry at large.
All posts must be identified, but the editor will suppress name and contact details if there is a sensitive reason.
Rollo Manning - A Regular Column Reporting the News Behind the News
Pharma-Goss -with Rollo Manning
* The parliamentary merry go round
* To measure change you need the stats
* Depression drug does not kill
Neil Johnston - Management Consultant Perspective
A standard component of a consulting practice is research.
In fact, a management consultant’s hourly practice rate is often based on the top management rate in an industry, multiplied by three and having research apportioned one-third, administration one-third, and a personal hourly rate of one-third.
Research is intimately tied in with a problem-solving strategy, because the solution to problems creates the intellectual capital that can be sold on to clients.
Building an inventory of intellectual product, and the communication skills to display a “road map” solution for a client, is the first step in creating a consulting practice – a step that has to be in place before the first client is introduced.
This process is not dissimilar to the work that is undertaken in a clinical setting on behalf of a patient, and you are requested to observe the parallel process as this article evolves, hopefully taking the reader on a journey that is a blueprint for the direction of your pharmacy business/practice to 2010 and beyond.
The realisation that you need to stand on your own two feet is slowly reaching pharmacist consciousness - there are no reliable helpers or partners and traditional protective legislation is no guarantee against a range of vested interests, waiting to swallow whatever palatable bits of pharmacy practice come their way.
The list of predators include wholesalers, manufacturers, doctor investment groups, naturopath groups, and national and global retailers plus any others that may come out of the woodwork.
Pharmacists have traditionally been fiercely independent and have difficulty working closely with each other, while simultaneously being in competition with each other.
This must end if survival is envisaged.
New forms of organisation are required and a reality check needs to occur on what really are the barriers for mutual cooperation to provide a balancing market force against the increasing range of predators.
Garry Boyd - From an Intellectual Capital Perspective
Editor's Note: Back in 2002 the PGA lodged a very general patent which seemed to be a "grab-all" for the process of Internet dispensing and associated activities.
It seemed to blatantly ignore the large volume of "prior art"that existed at that time.
Concurrently with this grab for systems power, the PGA has used its considerable influence to suppress any competitive system that could achieve any degree of connectivity between the professions, hospitals and government agencies.
Given that through FRED, the dispensing system controlled by the PGA, is claimed to have more than 50 percent of pharmacist desktops, this behaviour may be in breach of competition law, as the PGA has an obvious conflict of interest in its misuse of power.
The patent involves a dispensing system working like an Internet post office.
Government also appears to be playing a role in this because the PGA vision of a post box system will allow government access to all those prescriptions it has not been able to get at, previously held in the computers of community pharmacy.
The patient will be least considered, because they will have to wait in a pharmacy for their electronic prescription to be downloaded via a smartcard Medicare card - and any vision of a smoother workflow (and heaven forbid) a faster and improved patient service - will be negated.
Guess who will receive the blast if a prescription is held up due to any number of electronic problems, including data loss.
The stated reasons for such a system is to prevent prescription channeling and allow patient access from any pharmacy in Australia - reasons that arguably do not provide any benefit to patients or pharmacists over the current "hard copy" system.
On the other hand, a point-to-point system would provide benefit, allowing extra pharmacist time to prepare patient information and counseling, plus an ability to smooth out internal dispensary workflows.
Our resident writer on patent issues is Garry Boyd, and he picks up the story.
Con Berbatis - A Pharmacy Researcher Perspective
Editor's Note: Pharmacist-only medicines and the dominance of pharmacist ownership of pharmacies are two pillars of pharmacy practice in Australia.
Four leading articles in the April 2007 Australian Journal of Pharmacy challenged these structures.
Con Berbatis concludes from research results that electronic medication recording systems (EMRS) operating in over 800 pharmacies in British Columbia since 1995 and in Queensland since 2005 offer the most practical option to support these pillars of practice.
Neil Retallick - A Friendly Society Perspective
Where I work, the first news headlines that announced there were to be reforms to the PBS pricing structure that involved a 25% reduction in the pricing of generic medicines, the fear and loathing across the business was palpable.
$2 billion dollars in Government savings had to come out of somebody’s cash register.
As is the case with all pharmacies over the last several years, there has been considerable effort put into generic drug substitution to boost the otherwise flagging gross profit margin in the dispensary.
The additional discounts being offered by the generics suppliers was a very significant contribution to dispensary profit.
Not something anybody wants to give up.
Now, some months and a lot more information later, the question is not about who’s going to lose out.
Rather, it becomes, “Where’s the peanut”?
Stephen Carbonara - From an Independent Professional Pharmacist Perspective
During my regular readings over the last month, I happened to stumble across various articles from the UK which I found to be quite pioneering.
In this day and age of pharmacy based payments for pharmacists, some of our UK counterparts are developing new ideas to further promote the idea of the independent pharmacist.
There are now discussions occurring in the UK about developing a Royal College of Pharmacists.
This would be much along the same lines as the Royal College of Physicians or Royal College of Surgeons; noting that it would be a college of pharmacists not pharmacy in general.
Karalyn Huxhagen - A Queensland PSA Councilor Perspective
Pharmacists are very time poor and whilst they all know they need to keep up their clinical competencies the reality of achieving this is often a sad tale.
One of the many organisations that produce fantastic material for pharmacists is the National Prescribing Service (NPS).
There is a pre-conceived idea among some pharmacists that NPS is a government organisation designed to deliver the messages of ‘big brother’, the Australian Government.
While the funding is certainly from the Australian government the organisation is managed and run as an independent organisation designed to deliver quality use of medicine messages to Doctors, specialists, pharmacists, nurses and consumers.
Pat Gallagher - An IT Consultant Perspective
I have relatives who were successful journalists and columnists while I can only pretend to be remotely competent at the art.
This month I thought I would be a clever dick and write about things under a musical theme – such as the tune and the words of ‘Love is in the air ’.
You know – the John Paul Young classic - ‘every sight and every sound’.
But naw, I realise it is too corny even to try and convey the mess we are in with the sights and sounds of e.health events.
As well as the fact that there is absolutely no love in the air towards and among our wisest sages even those whom get paid to deliver outcomes.
Chris Wright - Dispensary Systems Perspective
Many of you will be aware that this writer has long had an interest in automated dispensing, and you will also be aware that I prefer the expression “assisted dispensing”, as the word “automated” indicates a lack of human interaction.
Certainly I’m being pedantic, but the Victorian Drugs, Poisons and Controlled Substances Act of 1981 clearly prohibits the use of an “automatic machine” for the sale or supply….etc, etc.
The other States and Territories have similar Acts in place dealing with the same.
Although none of the equipment available in this country could be described as “automatic” in any way, there seems to be the quite irrational fear by many that some sort of mutant cigarette vending machine is going to threaten the very core of Pharmacy.
Dr David More - From a Medical IT Perspective
In the last few weeks we have had a number of reminders that management of the privacy of patient records remains a contentious and difficult area.
The first key reminder came in late February 2007 when Paul Feldman, co-chair of the American Health Information Community’s (AHIC) Confidentiality, Privacy and Security Workgroup, submitted his resignation to the interim National Coordinator for Health Information Technology at the Department of Health and Human Services (HHS).
AHIC (which has the same role as the Australian Health Information Council – also rather co-incidentally AHIC) is the peak health IT policy advisory board in the US and provides advice directly to the US Secretary for Health and Human Services (the equivalent of our Federal Health Minister).
In his resignation letter Feldman writes that the workgroup “has not made substantial progress toward the development of comprehensive privacy and security policies that must be at the core of a National Health Information Network (NHIN).”
Given this resignation comes after six meetings and many months of work, the degree of difficulty in reaching a consensus between parties is obvious.
Barry Urquhart - International Conference Keynote Speaker
Modern business demands a different, dynamic and open, sharing approach to doing business and establishing relationships.
The merchants of the middle ages travelled the world to secure supplies and ownership of produce and products.
In many instances, they were the forward guards and catalysts for the era of colonialism. Territorialism, control and ownership were the mantras of the day.
Colonialism progressively collapsed throughout the world in the 1940’s, 50’s and 60’s.
Many former powers still today bare a considerable burden of the past, shackled by past practices and commitments.
There are many parallels in business.
Stuart Adams B.App.Sc (Nutrition and Food) - From a Nutritional Activist Perspective
As a nation, we are getting fatter and fatter.
It is now estimated that approximately 60% of the Australian adult population are overweight or obese; a figure which has more than doubled over the past two decades.
Given the health complications associated with carrying excess body fat, these figures may sound bad from a public health perspective, but not so from a business point of view, as many overweight people are willing to fork over a considerable amount of money to anyone able to offer them a solution.
In fact, the average Australian woman spends around $250 annually on weight loss – many doing so even if not overweight! 
Given that the population is certainly not getting any thinner, it would seem apparent that whatever it is that people are buying isn't working.
One may therefore start suspecting that the key to successful weight loss must be some kind of well hidden secret, and consequently set out to find this secret, spending a lot of money in the process.
Ken Stafford - A Consultant Pharmacist Perspective
At a CE meeting earlier this week someone posed a question to me. “How can we get pharmacists to become more involved in various health promotion programs?”
We tossed this around for a while and concluded that current community pharmacy practice, where remuneration seems to depend on long hours and high script numbers, mitigated against greater involvement in these activities by pharmacists.
This led to a follow up question, namely “How would you change things?” (Note to self : learn to keep quiet in future.)