Welcome to the March edition of i2P – Information to Pharmacists.
You may have noiticed if you receive i2P by email, that we have simplified our mail out presentation.
This was because the code in our earlier version appeared to be too unstable to maintain, hence the simpler presentation.
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Volume 5 Number 11
Regular updates from the global world of pharmacy.
Access and click on the title links that are illustrated.
Headlines in pharmacy media over the past month have signalled a new intensity in the emerging turf war between doctors, pharmacists and nurses.
The ringmaster orchestrating in the background is “Big Pharma”.
Consider the headline “GP push for pharmacy ownership” appearing in Pharmacy News on the 23rd February 2010.
According to the article text, the Pharmacy Guild of Australia (PGA) have slammed this as an attempt to divert attention away from another Telegraph article illustrating donations made by one Pharma company to various self-help groups. Plus on the same day hosting an extravagant GP educational event.
Most of us will have seen the graph that plots the two revenue streams – dispensary and retail – for the average community pharmacy over the last twenty years. It shows that the revenue for the average pharmacy was split about 50/50 way back then. It also shows a rapid increase in revenue from the dispensary business over the last twenty years to the point where the dispensary generates around 70% of the average community pharmacy’s income. Such has been the impact of the Guild-Government Agreements over that time.
To put that in perspective, from the mid-1940’s to the mid-1980’s the typical community pharmacist sold as much front-of-shop product as he or she did prescription medicine. The shift to a reliance on dispensary income and profitability that has occurred over the last twenty years is a relatively short term phenomenon.
Two-year old Emily Jerry of Ohio died on March 1, 2006 as a consequence of an error made by a pharmacy technician and pharmacist.
In preparing a solution for intravenous infusion, the technician used an excessive amount of a 23.4% solution of sodium chloride (10x error), and the pharmacist failed to recognize the error.
The contributing factors surrounding the error were:
* Equipment breakdown
* Short staffing on the day
* Script backlog
* Technician was distracted by surrounding events
* Pressure by nursing staff claiming urgency
As I read the above list of contributing events I felt concern for the pharmacist trying to focus on getting a job done in a pressure-cooker environment.
I have been there in similar circumstances, but managed to survive.
A surge of interest around vaccination clinics in pharmacy emerged this week after a report that Charles Sturt University would train its pharmacy students to equip them with all the skills required to give vaccinations.
This came on the heels of a successful trial in Tasmania involving swine flu vaccine, nurse administrators and community pharmacy environments.
The Tasmanian trial demonstrated high rates of vaccination take up due to the convenience of the clinic and the high level of community trust in pharmacists.
A recent story emerging from the APP Conference was a vision of Kos Sclavos waving a document around called “The Roadmap – The Strategic Direction for Community Pharmacy” that was supposedly a draft blueprint for professional services development.
It was incomplete and therefore not available for general view.
And you need to ask what purpose it served given the debate surrounding professional services over the past three years and the paucity of PGA development information.
Yet again the PGA has it wrong, as it appears that there was little input or collaboration with the PSA.
When I read articles such as the one following, it really sets up a feeling of resentment.
The haphazard management processes of the Dept. of Health and Ageing (DoHA) as illustrated, means that there is little research or care being invested in their processes, so that policies, communications and actual programs are simply not believable or capable of being delivered.
While the article certainly has a bias, it does have the ring of authenticity about it as it was written by one of the "insiders" within the DoHA.
Follow the writer's amusement when he learns that the DoHA has come in under budget, which to staffers means "training" - a euphemism for an uninhibited spend on conferences in exotic places.
Recent calls by Minister Roxon to further reduce costs within the PBS will effectively reduce the viability of pharmacy by stripping out its profitability base. They sound very hollow when compared to the largesse generated within her own department.
It also appears that faulty extrapolation of the figures contained in the Intergenerational report released in late 2009 caused this decision.
Accident or deliberately engineered?
You go figure.
And this on top of a mighty effort by pharmacists to bring the PBS back into a manageable condition under the Fourth Agreement, certainly sends a message of unfairness throughout the pharmacy community.
And it also appears that accountability seems to have been left behind by Minister Roxon as illustrated by the manner by which people are hired and fired, ministerial visits to various communities arbitrarily cancelled and the shallow depth of information transmitted by press release and the paucity of research overall.
"Yes Minister" is certainly alive and well and readers are encouraged to follow the full story through the link provided.
The following article recently appeared in “About Strategy + Business”, published by the global consultancy firm Booz & Company.
It is a rather long article, but it forms a useful reference for the profession of pharmacy in the US, and by analogy, Australia.
And it is more of a “white paper” than a straight article, but is recommended to Australian pharmacists to adapt to their forward plans.
Much of what is said is already evolving in Australia, but as yet remains haphazard and uneven in development.
This is a result of a division within pharmacy ranks itself, with the Pharmacy Guild of Australia hijacking the infrastructure of community pharmacies to deliver professional services that have minimal support of those pharmacists who actually have to provide the delivery.
This approach by the PGA has resulted in a workplace that is not pharmacist-friendly, concentrating on supply rather than professional development.
New pharmacists have nowhere to go except to other environments such as GP practices and hospitals – or as many have already done so – leave the profession for a more rewarding career.
Government has played a big part in this uneven development because of its insistence in dealing with one pharmacy organisation to represent the entire profession.
The business of pharmacy should be represented by the PGA; the profession of pharmacy should be represented by the Pharmaceutical Society of Australia (PSA).
The two organisations ought to be capable of mapping out a partnership that is mutually respectful and supportive.
The politics associated with greed and power are the dividing factors here, with the PGA being the main offender. In alienating itself from the profession, the PGA runs the risk of losing support from a range of pharmacists working in different capacities - from employees to owners.
The risk is that with such a divided profession, pharmacy will be “picked off” by other health professions and government.
The following article is worth printing out and rewritten to accord with your own objectives.
Volunteers over the age of 60 are being sought to participate in a new studyIngredients found in oats could boost your brain power into old age.
Researchers at UniSA’s Nutritional Physiology Research Centre are investigating whether an oat extract can improve cognitive performance in older adults.
Research Professor Peter Howe said while the physical health benefits of oats were well known, there was growing interest in how oats could improve mental health.
The signs of pressure on health and aged care funding are emerging rapidly and being reported on an almost daily basis.
Government has recognised the problem but has done little to get ahead of the problem.
They will eventually be forced to take the cheapest solutions to the various problems, and if pharmacy can get its act together, it can partner government and aged care facilities with solutions.
Automated packaging of dose administration aids appears to be emerging as one solution.
Community pharmacy is well positioned to provide infrastructure support as well as primary healthcare solutions if the rift between clinical pharmacists and pharmacy owners can be resolved.
Pharmacy in the home solutions would also take pressure off the system.
Meanwhile, evidence points to aged care facilities coming under financial pressure that could lead to destabilisation.
More grim news for aged care
Source: Australian Ageing Agenda
A new structure and independence for the Pharmacists’ Support Service
The Pharmacists’ Support Service has taken the first step to becoming a fully independent service which is funded to service pharmacists throughout Australia by becoming an Incorporated Association. Members met in February and voted to accept Articles of Association and a new independent Committee of Management representing a wide range of national pharmacy organisations.
"The good, the bad and the ugly" will be presented at a PSA Conference in Lorne, Victoria, on March 20-21.
All you wanted to know (but maybe too embarrassed to ask) will be delivered, including sexually transmitted infections, contraception, conception and pre/post natal care. Top clinicians have been invited to present the latest clinical information and advice, including IVF expert Professor Gabor Kovacs from the Monash University IVF team.
The University of Melbourne’s Institute for a Broadband Enabled Society (IBES) hosted the launch of the Victorian eHealth Network, a collaboration that will promote and support the application of IT to improve health and wellbeing.
The Network, launched at the University and boosted with an $80,000 grant from the State Government of Victoria, will provide a forum for greater communication between government, industry, research organisations and education providers to foster growth, innovation, and the development of new eHealth products and services.
The Rudd Government will invest $632 million to train a record number of doctors - to tackle doctor shortages, expand capacity and deliver better health and better hospitals, the Minister for Health, Nicola Roxon has announced.
In total, the Rudd Government’s investments will deliver an additional 5,500 new or training General Practitioners, 680 medical specialists, and 5,400 Prevocational General Practice Placements Program (PGPPP) training places over the next ten years.
Following on from calls to government (by the AMA) to allow GP ownership of pharmacies the Medical Observer Magazine commissioned a national survey of doctors to see who would welcome ownership.
Employing Cedegim Strategic Data the findings were as follows:
In a recent media release by the PSA, National President Warwick Plunkett said:
”The health debate between Prime Minister Kevin Rudd and Opposition Leader Tony Abbott was primarily about addressing the health of the system, and not the health of Australians.
Prime Minister Kevin Rudd and the Opposition Leader Tony Abbott both focussed on funding and neither made any mention of the most accessible health-care professionals in Australia - pharmacists.”
The turf war between GP’s, nurses and pharmacists has been heating up over recent times. Of course it is due to the stimulus of federal budget submissions – a time when all health professions have to be visible (and audible) to ensure that their share of the “pie” is secured.
And to attract funds there has to be some well thought out plan that coherently thinks through the best methods of utilising those funds, particularly in the area of primary health care.
Pharmacy has always been in the primary health care space, but has often had an “invisible” presence because it has operated outside of the main streams of patient care, not being integrated with other health care providers.
We, as pharmacists, know what we can do and how we can provide it, and we are often surprised when our profession is overlooked in various government programs and activities.
In part, this is because doctors have tended to “drown out” any proposed pharmacy initiatives, aggressively construing any forward activity as being an intrusion on their turf.
However, an alternative reason is because pharmacy is represented by a trade union of employers (PGA), a minority but wealthy group of pharmacists that dominates any negotiations with the federal government.
Pharmacies only represent infrastructure to deliver services, and an excellent infrastructure at that.
The actual services have to be provided by pharmacists and specialised technical staff and it is here that cracks appear in the development of pharmacy practice, because they are competed with and unsupported by the PGA.
There is a great potential for a genuine partnership to develop between infrastructure providers (pharmacy owners) and professional service delivery (clinical pharmacists within their own service business structures).
Nurses have suffered similarly and it is only in recent times that the general practice nurse has been perceived as a valuable asset and one that drives doctor funding submissions to carve out a section of the federal budget that includes expanded practice nurse numbers.
However, nurses have been able to gain extra training and qualifications and are able to practice independently as clinical nurse practitioners, being able to diagnose and prescribe for a limited range of conditions.
They too are looking for a suitable infrastructure and environment to work from as well as productive partnerships to integrate with other health professionals.
The pressure cooker is heating up and something has to give.
The following recent news extract is illustrative of this problem.
The news item is taken from Pharmacy News dated 26/02/10 and is written by PGA national president, Kos Sclavos.
i2P has asked Mark Coleman to provide a comment following this news extract.