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Regular updates from the global world of pharmacy.
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I read in I2P a couple of months ago about the impending increased number of pharmacists being produced by the ever expanding number of pharmacy schools and the negative impact this might have on community pharmacists’ salaries.
I was surprised to learn that the problem has already occurred in New Zealand where, in Auckland with an oversupply of pharmacists, qualified registered pharmacists are being employed for the princely sum of $NZ22.00 per hour! This equates to around $NZ44,000.00 per annum and doesn’t provide much of an income when the registration fees and tax is deducted, particularly when one considers that the pharmacist has spent four years working for a degree and a fifth year completing an intern programme. In addition pharmacists must conform to a stringent Code of Ethics, be of good character, drug free, have no criminal convictions, and be subject to disciplinary proceedings if suspected of incompetence or any wrongdoing.
Nurse practitioner prescribing PBS misunderstood
In a sense the PBAC has passed the buck on Nurse Practitioner prescribing to the Advisory Committee on Medicines Scheduling (ACMS) or the Secretary of the Department of Health and Ageing.
At present there is no way a NP can prescribe anything more than Schedule Three medicines under the provisions of the Standard for the Uniform Scheduling of Medicines and Poisons (SUSMP).
In some jurisdictions there is in place a select list of medicines that has been approved by the Chief Health/Medical Officer for NP prescribing.
Such a list has existed in the NT for 23 years and is widely used for prescribing PBS medicines by nurses and Aboriginal health workers in remote locations that are listed in the Gazettal Notice that describes the action.
These “prescriptions” can then be dispensed by the practitioner using the special provisions of supply under Section 100 of the National Health Act for PBS to remote Aboriginal Health Services.
Decline in our profession has reached a point of no return. Events will now play out until we all find ourselves with no professional place to go.
At that point the only way out will be up, provided we have sufficient emotional and financial resources left to support an elevation.
For 10 years i2P has dogged the leadership of the profession of pharmacy to try and get some real change and growth, plus a sense of direction and purpose for the profession of pharmacy (not just the business elements of pharmacy).
We believe that we have failed because we are starting to see professional decay in the form of unemployed pharmacists, no new professional services (except for a few “top down” computer programs), a depressed outlook and the existing work of dispensing becoming “crunched” through the increasing use of automated dispensing machines and the development of the role of the dispensing technician.
It means pharmacy leaders have definitely not done their homework and have been divided in their efforts. They have failed miserably.
The setting may have been an idyllic, bathed in sunshine Hamilton Island but the 300 attendees at the Pharmacy Conference 2010 spent much of their time pondering the stormy seas confronting community pharmacy over the next several years.
Seventeen speakers over three days covered a lot of ground – appropriate given the broad range of healthcare issues and opportunities that must be addressed by pharmacists, their suppliers and pharmacy wholesalers as the Government reshapes the landscape of community pharmacy.
Over the next couple of issues of i2P I will summarise some of the topics discussed.
Safety concerns have been raised about the increasing use of breast imaging devices for breast cancer screening that are not part of the mammography screening program.
These include ‘mammographic computed tomography laser’, thermal, tactile and ‘electrical impedance’ imaging systems.
Costing upwards of $150 per appointment, practitioners state that they offer “the local community a safe option for mammography”.
Claiming that their devices are Therapeutic Goods Administration (TGA) approved, are these therapists providing an “objective, pain free, reproducible, sensitive, radiation-free, effective, reliable and accurate service” or are they putting lives at risk?
Companies, products and services which have long benefitted from favoured market positioning founded on quality, value, differentiation and innovation have, in recent times, been tempted to respond to the economic downturn and discounting-led competitor actions with advertising, merchandising, promotions and marketing, which have focused on sales, prices and incentives. The decisions made and the underlying rationales are understandable, but not advisable.
Years of astute strategic development are being dismantled by broadbrush short term tactical initiatives.
Consumer perceptions and value constructs are being discounted.
The market positioning of companies, products, services and workforce teams are, or have been, compromised.
Emerging within both countries is a primary health care system called GP Consortia in the UK and Medicare Local in Australia.
It is an important development from a pharmacy perspective, but Australian pharmacy appears to be sidelined from the beginning.
Both organisations are being constructed from an almost identical start-point, but the UK model appears to be slightly ahead in its evolution with many identified policies and protocols being in place.
This is a legacy established through Primary Care Trusts that are now being abolished in favour of GP Consortia, groups of GP practices that will be allocated a budget and trusted to commission services as they see best. The UK Government believes that GPs have the clinical knowledge and front-line patient interaction to be better placed than detached managers to decide where funding is allocated. This is not an entirely novel idea.
It bears some similarities to GP fundholding introduced in the 1990s (which was not regarded a resounding success), although it is compulsory and on a much larger scale.
Walgreens, the giant US retail pharmacy chain, is evolving its image into a “retail health and daily living store”.
It wants to own all things in the marketplace of “well”.
Australia is slowly moving towards this ideal, but current offerings need more research and investment to match the Walgreen vision.
Australian pharmacies have yet to realise that health is being rapidly commoditised.
Even hospitals have been moving towards a reimbursement system that quantifies a service and the detailed quality expected outcomes for a price( a package that eliminates inefficiencies).
This forms the basis of a catalogue of services – a health supermarket.
A recent article in the British Journal of Dermatology (BJD) explored the issue of patient satisfaction and efficiency of nurse prescribing in dermatology services in the UK.
Dermatology has been one of the disease states that pharmacists have been involved in as “counter prescribers” over many years.
Nurse prescribing in this disease state is thus directly competitive and is delivered with some major differences when conducted in Australia – Medicare subsidises the consulting fee and the actual service is performed in more private and professional surrounds.
The BJD asserts that “skin disease can have a huge impact on quality of life for sufferers and their families. Nurses have an important role in the delivery of specialist dermatology services, and prescribing enhances the care they provide. The views of dermatology patients about nurse prescribing are unknown.”
The world has changed. And will continue to change.
There are many reasons for this: global warming and the evolving climate; ceaseless scientific progress; the demographic explosion; globalisation.
We can't stop the evolution of the planet, but we can suggest guidelines and proposals to interact responsibly with it.
The Barilla Center for Food & Nutrition is an Italian think tank and driver of change set up to gather knowledge globally, analyse it and propose solutions to negotiate the challenges of the upcoming future.
Encouraging general well-being through a healthy and sustainable approach to food, means growing towards a better world.
Professor Michael D'Occhio, from The Global Change Institute at UQ, says that Australia's domestic food market will come under pressure with the world demand for food expected to almost double by 2050.
He says a national debate on how much food Australia should produce is required before any decisions are made about water allocation from the Murray-Darling Basin, which produces one-third of Australia's food.
Professor D'Occhio says Australia currently produces enough food to feed 80 million people, but demand for Australian food from overseas markets is expected to explode in the next few decades.
A team of Australian and Chinese scientists has pioneered a new way to make clean energy from land so contaminated with toxic waste that it is good for little else. A collaboration between researchers from Australia’s CRC for Contamination Assessment and Remediation of the Environment (CRC CARE) and its offshore partners HLM Asia Group and Shaoguan University has delivered proof of concept for a new system for cleaning up badly polluted land that produces greenhouse-friendly energy for homes and industry at the same time.
The Gillard Government is getting on with the job of reforming our health and hospital system and today took the important next step in establishing a network of primary health care organisations – Medicare Locals – by releasing a discussion paper on their planned roles, functions and governance.
The discussion paper outlines what activities Medicare Locals will undertake, how they will be structured, and how they will engage with patients and health providers.
Most Australians would be happy to visit nurse practitioners for prescription renewals and everyday health concerns such as colds and flus, according to preliminary results from a national study.
The Australian Primary Health Care Research Institute (APHCRI) at ANU and Health Care Consumers’ Association of the ACT (HCCA) are investigating people’s views of the role of nurse practitioners in primary health care services, such as general practice.
From November 1 2010, nurse practitioners will be able provide services funded under the Medicare Benefits Scheme (MBS) and prescribe medications that are subsidised by the Pharmaceutical Benefits Schedule (PBS).
An increasing number of women going online with health queries means there should be more focus on ensuring plenty of reliable advice from health professionals is available in cyberspace, according to Queensland University of Technology (QUT) research.
Dr Julie-Anne Carroll, a lecturer with QUT's Faculty of Health, said online advice was sought by many women along with input from family and friends.
The findings have implications for community pharmacy where the majority of customers visiting a pharmacy are female and where few pharmacies have an Internet presence in straight information terms.
An opportunity exists to develop a cooperative information site and to mentor patients internally within the pharmacy as to how to use that site utilising and promoting an in-store computer.
Information pamphlets to support the system would assist clients when accessing from their home.
Compliance is a "watchword" that is very prominent in pharmaceutical industry literature.
Compliance is also difficult to achieve with some patients, yet to achieve a result may be as simple as changing the dispense container to a more simple and practical design.
Arthritis patients would be quite amenable to this approach, given their hand and wrist strength is compromised by pain and joint deformity.
But don't we all have difficulty with those child resistant tops on pill containers?
So maybe one major factor in compliance is pill container design.
But not to look at the problem in isolation, label and compliance information design also needs an overhaul.
From a pharmacy perspective the new design presented below gives sufficient area to attach a standard label plus any reinforcement and compliance labels, yet still offers a strong level of child safety.
It may be early days, but primary and aged care health is beginning to be promoted through innovative concepts.
We have already heard about GP Super Clinics and Medicare Locals, but we are now seeing new ideas coming to the fore in Aged Care.
In an innovative move, Hammond Care has entered into an agreement with the university of NSW (UNSW) to pioneer a blended approach to servicing Aged Care patients.
Given the fact that Australia's population is ageing rapidly, pharmacists interested in the Aged Care sector and the supply of dose administration aids, should monitor these developments closely.
If you are a consumer of electricity in Australia, you have no doubt noted that your electricity account has increased exponentially and well beyond your ability to reduce it through the use of government subsidised solar system generation, even if it can be connected and sold back to the grid.
Perhaps a cost offset may become available through the purchase of an electric car?
A saving on that rapidly depleting petroleum energy resource?
Major utility companies are already exploring the potential to sell portable chargers to top up your electric car.
But will there be any benefit if electricity prices continue to rise and rise?
Something will have to give before energy costs create a very serious social upheaval.
New technology systems are required to create cost offsets that will work to balance out energy cost problems.
New technology developed by CSIRO might be part of the answer.
Researchers at Baker IDI Heart and Diabetes Institute in Melbourne are publishing the results of a world-first trial of a new minimally invasive procedure for the treatment of difficult-to-treat high blood pressure by using radio waves.
In the first international randomized controlled trial of the technology, sympathetic nerves leading into and out of the kidneys were silenced using radio frequency energy emitted by a catheter device inserted into the renal arteries through the groin.
Recent Swedish research has confirmed that 70-year-olds born in 1930 and examined in 2000 performed better in the intelligence tests than their predecessors born in 1901-02 and examined in 1971.
There were no differences in test results between 70-year-olds who developed dementia and those who did not over the next five years in the group born in 1930 and examined in 2000, while many of the tests identified early signs of dementia in the group born in 1901-02.
"The improvement can partly be explained by better pre- and neonatal care, better nutrition, higher quality of education, better treatment of high blood pressure and other vascular diseases, and not least the higher intellectual requirements of today's society, where access to advanced technology, television and the Internet has become part of everyday life," says researcher Dr Simona Sacuiu.
Change is one of those activities that we often appreciate seeing in others, but it is always uncomfortable when it is happening to us personally.
Yet, as one philosopher once said “In the midst of change, everything remains the same.”
Government is renowned for taking an existing process, breaking it up and giving the reformatted bits a different name, and sometimes even a different owner.
Down the years, pharmacy has remained resilient, but it is beginning to show signs of stress due to poor vision, poor management, a heavy dependence on government and a “greed is good” syndrome.
It is the latter that weakens the moral fibre and strength of pharmacy.
Changes in UK pharmacy are often reflected by adaptation into Australian pharmacy.
So when a major change is signalled in the UK, it is useful to consider what impact it may have in Australia and in what format.
i2P asked Mark Coleman to consider the import of the following article that appeared in PJ Online on the 26th October 2010.
His comments appear below the article.