Publication Date 01/09/2009         Volume. 1 No. 4   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the September 2009 issue of i2P E-Magazine - Information to Pharmacists.
In this edition I would point you to the Pharmedia link where trends in US pharmacy consumers are noted and matched to the Australian counterpart.
There is a strong similarity between the two countries.
In this commentary a direction and a strategy is suggested.
Please feel free to add your comment in the panel provided at the foot of this commentary, as it is a very important issue for Australian pharmacists.

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Another Step Back?

Neil Johnston

articles by this author...

Introducing current ideas, perspectives and issues, to the profession of pharmacy

Anyone who has followed the story of convenience clinics in the US would have come to a simple conclusion very early in their investigations.

That conclusion would have been that with a few exceptions, the market being serviced in primary care was identical to that serviced by Australian pharmacists.

What was commonly known as “counter prescribing” in Australia became known as the “Minute Clinic” or Rediclinic in the US.

Now we have a development here in Australia where nurse-led clinics are being hosted by pharmacies, with the initial players being the Revive Clinic and the Pharmacy Alliance Group, consisting of 186 franchisees, all based in Perth, Western Australia.

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Criticism of this development has come from the Pharmaceutical Society of Australia and the Australian Medical Association citing the fact that in the prescribing area for minor ailments, nurses do not necessarily have the experience that pharmacists have already acquired, and that there is a potential for conflict of interest.

The US clinics are quite often located in supermarkets or very large pharmacies and no doubt this is where the Australian counterparts will end up. Both these environments do not appear to be interested in pharmacy-led clinical services.

It is no accident that the AMA has labelled these new clinics as “supermarket medicine”.

What was previously “under the radar” with pharmacists in past years has now become highly visible with nurses.

The Pharmacy Guild of Australia welcomes the advent of nurse prescribers because of the new volumes of prescriptions generated, reinforcing their primary interest in supply side activities only.

The US clinics do not seem to have any concerns as to conflict of interest, where the pharmacy/supermarket hosting the clinic is perceived to have a captive market in respect of prescriptions generated. Patients that patronise these clinics appreciate the convenience factor and the concept has received strong support.

The PSA and the AMA see a definite conflict of interest and no doubt will oppose the expansion of the new clinics well in to the future.

While nurses here in Australia are being given access to PBS prescribing, it is not clear whether the actual advisory service will be funded from government sources, paid for privately by patients, or subsidised by the host pharmacy. In the US the patient pays for the nurse consultation and the prescription costs privately, with some subsidies made available from various private health insurance plans (if the patient can afford the insurance premiums).

My view is that provided there is a clear delineation in function i.e. that the clinic function is separately owned and there is no pecuniary interest either way, then it is immaterial who hosts the clinic.

Pharmacy hosts would receive rental for space plus the flow on prescription business.

Nurse clinics would be able to access a pool of patients already visiting the pharmacy, plus those that they would attract in their own right.

In the US, convenience clinics have attracted doctor investment and there is every reason to suppose a similar occurrence will develop here in Australia.

My disappointment is that this clinic development has not utilised clinical pharmacists from the outset, defaulting to nurses in this instance (and naturopaths prior to that).

However, there is always opportunity in any perceived adversity.

With the nurse clinic pioneering the process, clinical pharmacists will be able to observe what will work and what will not.

The brunt of the conflict of interest issue will be worn by the pioneering nurses and pharmacies, allowing a lead-time for clinical pharmacists to get their act together.

Convenience clinic development involving nurses, has the potential to split pharmacists further in the sense that small pharmacies may feel disadvantaged as they see their governing body (the PGA) encourage more “captive” prescription markets, discriminating again in favour of the larger pharmacies.

There is a potential opportunity for the smaller pharmacies to separately combine and create a shared clinical alliance hopefully utilising clinical pharmacists.

Maybe, as the clinic potential builds the wheel may turn in favour of clinical pharmacists, because theoretically, they have always performed well and have been in the forefront of primary care forever.

The “invisibility” that has occurred in recent years, particularly in government circles has for a long time baffled this writer.

I have learnt from experience that when something does not make sense it is being driven by a specific political agenda.

PGA acquiescence in all but prescription dispensing has me believing that the agenda very much has their support – and paid support at that.

In a broad sense, the developments that are occurring are heralding in change and competition in the primary care area.

It has been a criticism of GP’s that they do not tackle complex health problems, preferring to refer patients to a range of specialists. This has added considerably to the cost of health and the inconvenience of patients.

As the shifts in the mix and balance of health services begins to become apparent, and strategic alliances are formed within the health professions we may well see the mythical “health care team” emerge with true competition prevailing.

Underpinning that development will be a portable health record for patients, accessible by health professionals of the patient’s choice.

And that can only result in affordable quality health care for patients as they truly learn how to taken control of their own health choices.

For those interested in the structure of US convenience clinics, please go to this link:
http://www.retailclinician.com/
Note that this link has been listed in the e-publications section of i2P for approximately two years.

To review services and charges in the US based Minute Clinic go to:

http://www.minuteclinic.com/en/USA/Treatment-and-Cost.aspx

To review current services and charges at the Revive Clinic go to:

http://reviveclinic.com.au/clinicservices.asp

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