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From the desk of the editor - Introducing current ideas, perspectives and issues, to the profession of pharmacy
Issue 66: November 2007
Welcome to the November edition of i2P – Information to Pharmacists.
Last month I opened up the editorial page by stating:
“One gets the feeling that we are currently on the edge of a great change that will manifest in community pharmacy in the coming months, picking up direction in the beginning of 2008.”
If ever confirmation was needed to back that statement, a report known as
Katie Butt - From a Good Prescribing Perspective
The National Prescribing Service (NPS)is a valued independent resource for good and unbiased prescribing information and education.
Given the marketing pressures applied by global drug companies, Australia is blessed to have such a resource.
Pharmacists are moving closer to a prescribing role within the health system and it is appropriate that i2P promote the message of the NPS.
This Month: * Partnership to improve asthma inhaler use * Consumer reluctance to use generic medicines unwarranted * New prescribers to benefit from QUM programs * When switching brands isn’t recommended
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 - News Items, Background Information and Items of Interest
Organisations with pharmacy connections are invited to share their news, product releases or opinions in this column.
* Durolax Name Change
* HIP Newsletter Update
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).
* Patient Safety & Quality Improvement - Embedding a Culture of Safety in our Hospitals & Health Organisations
Two Day Conference: 4 & 5 December 2007 - Venue: Sydney
* National Pharmacies-Calendar of Events - Pharmacy 2008 Conference
Rollo Manning - A Regular Column Reporting the News Behind the News
With Rollo Manning
* LOOSEN THE SHACKLES ON PBS DISPENSING
* STUDENTS ADD VALUE
* CMIs ARE A LEGAL REQUIREMENT OF MEDICINE SUPPLY
* THE REMOTE PHARMACY THREAT OF CLOSURE
Neil Johnston - Management Consultant Perspective
The above provocative title was suggested by a recent story in the Washington Post, describing a patient visiting an after hours medical clinic, with a case of hives.
The patient was told she needed steroids and treatment with antihistamines over seven days.
No prescription was given – the patient was given a dose on the spot and the opportunity to purchase the balance on her way out of the surgery.
Given the late hour (11pm) the patient gratefully accepted.
For the moment, approximately 10 percent of prescriptions are dispensed by doctors in the US.
The title given to this type of dispensing is “Point of Care (POC) Dispensing”.
Dispensing physicians in the US are required to register with the Pharmacy Board
Market researchers predict that physician dispensing could reach 25 percent in the next five to 10 years.
Con Berbatis - A Pharmacy Researcher Perspective
Editor : On October 3 2007 the FDA announced an enquiry into the public health benefit of creating a new class of ‘behind-the-counter’ (BTC) non-prescription agents available only after intervention by a pharmacist. In Australia , pharmacy is required to provide supporting evidence of the benefits of both Schedules 2 (pharmacy) and 3 (pharmacist only) medicines otherwise they may be combined. These contradictory developments in non-prescription drugs pose challenges to pharmacy internationally .
Con Berbatis who presented research results to the US Nonprescription Medicines Academy (NMA) and at the USC LA school of pharmacy reports on events affecting non-prescription drugs in US and Australian pharmacy
Stuart Adams B.App.Sc (Nutrition and Food) - From a Nutritional Activist Perspective
Editor's Note: Stuart Adams is a qualified "Nutritional Activist" and has been examining weight loss programs that have multiplied through pharmacy in recent times.
We have been pleased to publish Stuart's commentaries, as they have been very direct and unambiguous.
The end result is that some pharmacists are now clearly looking at what they are doing, and modifying their professional behaviour to ensure that what they now do is not seen to be deficient.
With pharmacy generally gearing up for a range of programs that might be called "assistive primary care" programs, that specialise in clinical support for mostly lifestyle diseases, it would be nice to be confident, so that when these programs are introduced, they will not be blindly followed according to manufacturer propaganda, but will be skeptically evaluated by individual pharmacists before they begin to endorse a clinical system or service.
Weight management is a good introduction to these activities.
Get to the real causes of weight gain and perhaps pharmacists may be able to blunt the diabetes epidemic that is sweeping Australia.
As you peel back some of the layers, you find sleep deprivation may be a causative factor and perhaps high insulin levels, as argued by some health practitioners.
I don't pretend to know the answers, but I would certainly enjoy finding out.
And more importantly, to be confident that what I am promoting has good evidence to back it.
Neil Retallick - A Friendly Society Perspective
The Pharmacy 2007 Conference held 5-8 September in Hobart was acknowledged as the best yet by the 250 delegates that gathered from across Australia to hear presentations that reviewed almost every aspect of the management of community pharmacy.
What follow are summaries of the presentations of three speakers – reflecting the diversity of topics addressed.
Next month three more speaker summaries will be published.
Carl Peeters - A Robotic Dispensing Perspective
Editor's Note: Carl Peeters is charged by his company, Lamson Concepts, with introducing the German invention that is the Rowa Assisted Dispensing Machine.
We are pleased to be able to help Carl introduce this technology to Australia, and we are excited about his prospects.
For the moment, Carl is seeking to contact pharmacists who may be interested in trialling the Rowa machine.
The benefits of becoming a trial site are that you become an early adopter in this new era of robotics and you get a head start in the reduction of your overheads if you become an intelligent user.
Carl continues with a discussion on the potential return on invested capital.
Chris Wright - Dispensary Systems Perspective
As we power towards a Federal election that may or may not have an impact on Pharmacy, it is clear that the battlelines of survival for pharmacies and those that work in them and supply them are jockeying for future position.
As this writer has previously said, the presence of Rowa in Australia is clear indication that we are finally embracing the notion that the use of automation in pharmacy is finally being recognised as a viable solution to managing an ever-increasing workload.
I’m not endowed with copious intellectual agility, but it’s interesting that in the UK, more than half of the 70 odd machines that have been installed in hospitals are Rowa machines.
My interest is in the fact that it could reasonably be argued that if Pharmacists are going to embrace automation, why not go the whole “hog” and have the medicine delivered to the pharmacist complete with printed label attached?
Garry Boyd - From an Intellectual Capital Perspective
Those of you that read this page each month will be aware of the ever-increasing workload patent offices have to deal with.
Uncle Sam has surprised the august world of patency with an innovative and progressive move. The New York Law School & the United States Patent Office are in the process of running a pilot program that involves public scrutiny of patent applications.
Some 250 patent applications will be made available to the public in an effort to solicit comment regarding known prior art.
In an interesting diversion from current law, reviewers will be able to give comment online, using collaboration tools.
Prior art that is both known published material, or, prior art known to the reviewer that is considered relevant by the reviewer can be presented to the examiner.
The pilot is restricted to computer architecture, software and information security, which are the most difficult areas of patency.
James Ellerson - A Marketing Consultant Perspective
From comments made by pharmacy proprietors and general discussions with individual pharmacists it is fairly apparent that stress levels within pharmacy environments are dramatically rising.
There is no doubt that so called PBS "reforms" are one major culprit, because the end result of these reforms is manifesting in a trend displaying an accelerated reduction in cash flow, reduced staff working hours or termination of specific technical staff, increasing work complexity induced through having to deal with PBS online errors and breakdowns.
Add to this a bit of accreditation pressure and a dash of competition from the larger discount pharmacies, and you have a near boiling point mixture of discontent.
Robert Forsythe - Globetrotting Community Pharmacist Perspective
Editor's Note: Dose Administration aids (DAA's)are becoming more prominent as their use becomes more universal- not just in a nursing home or other supervised setting.
Given that Australia's "baby boomers" are progressively moving into a reliance on dugs to treat their chronic illness, DAA's are set to become a way of pharmacy life, as a major tool to assist drug administration and patient monitoring - and keeping patients supported in their homes.
However, they are not without their problems as lead-writer Robert Forsythe points out, because he ends up with the problem in the hospital emergency department.
Klaus Petrulis gives us another view and a footnote to this discussion.
Robert Forsythe begins:
At the hospital where I practice we have been fortunate enough to be able to allocate some pharmacy time to our Emergency department over the last 9 months.
The idea of course is that the pharmacist will be skilled at obtaining accurate medication histories making the role of the medical and nursing staff more effective.
The pharmacist is also able to advise on the correct administration of critical care drugs.
Not surprisingly, some other professionals seem to find it difficult to find and interpret the information in what are often life and death situations.
Stephen Carbonara - From an Independent Professional Pharmacist Perspective
This is a question that I have recently wrestled with, and I’m sure every pharmacist has also wrestled with at least once in their career. The question is whether a pharmacist’s time is better spent in the dispensary away from customers or out the front of the dispensary conversing with customers?
Firstly let’s assume this as a very general question, and acknowledging that different situations require different approaches.
Furthermore, let’s also assume that the skills of pharmacy assistants are relatively consistent across the spectrum.
This then allows us to look specifically at our own practices, and enables us to make decisions that we feel will benefit the customers of a pharmacy.
Terry Irvine - Community Pharmacist Perspective
Why does it take so long for technology to be integrated into everyday functions?
Yesterday, I was talking to a lady who has been on our staff for a fairly short time and had not worked in pharmacy before.
I was wondering out loud why it takes a long time for technology to be incorporated into our workaday world.
I mentioned that when we had a computer business in Darwin we used to get computer journals from the U.S.
One journal, "Byte", had an interesting article on smart cards.
We thought it was a good idea, and that it could be used in transferring information on medical matters between prescribers and pharmacists, and provide ready information for anyone else who needed to know such as ambulance personnel.
We thought it was such a good idea that we attended a conference in Chicago, and visited an expert at the Ohio University.
Rollo Manning - A Special Report on Indigenous Health from Northern Australia
Editor's Note: Rollo Manning has a passion for indigenous health because he understands the problems of the indigenous community having spent a large segment of his professional career devoted to their cause.
Seemingly, because the indigenous problems are out of sight, mainstream pharmacy has difficulty aligning with or understanding the nature of the health challenges that they face.
Often, the only images portrayed are the negative one such as alcohol abuse, child sexual abuse, lifestyle disease and poor living conditions. All these images exist in the wider community, but there are a range of support structures in place there to manage these problems.
Pharmacy as a profession is doing little to support the disadvantaged indigenous groups, and it often appears that official pharmacy and government seem to collude to work against the best interests of indigenous people, particularly those living in remote parts of Australia.
Dr David More - From a Medical IT Perspective
Editor's Note: Given that climate change is believed to be inducing the number, frequency and ferocity of natural disasters, it seems logical that they may occur in greater numbers and ferocity.
The US leads off generally and dominates most activity of any description - and it seems that natural disasters are also included.
Taking hurricanes and bush fires as examples, the US seems to have the biggest and the best.
However, the US also seems to apply the lessons as these disasters occur.
For example, Hurricane Katrina triggered a move to set up a central database to house records for the victimes of that disaster, so that they could be efficiently treated.
After a difficult start, the Internet database was made to function (without security breaches), and has continued non-stop until today, handling victime of the recent fire storms that have bedevilled California.
David More ponders on Australia's preparedness.
After many years and multi millions of $'s, we do have systems that work, but none have been actively deployed.
Australia is definitely not immune from climate change and severe natural disasters, so why haven't the people charged with producing a suitable system, stepped up to the mark and introduced at least one system suitable for a major disaster.
Australia's unpreparedness is a political disgrace
Barry Urquhart - International Conference Keynote Speaker
Being comfortable is a curse!
Numerous leaders, managers and business owners in franchise networks, buying groups, cooperatives and branded marketing channels know the feeling only too well.
Endeavours to innovate, create, change and develop can be and often are frustrated, impeded, blocked or compromised by some individuals and businesses within the respective supply chains who are less driven, because they are comfortable
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.
In this edition of i2P, Dr Byrne comments on the association of smoking and mental illness.