Publication Date 24/02/2011         Volume. 3 No. 2   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the March 2011 edition of i2P.
The month of February has seen free enterprise in the pharmaceutical industry breaking out of the mould that is regulated health and upsetting any semblance of balance within community pharmacy.
Government negotiated price reductions with Big Pharma collided head-on with the new business model from Pfizer Direct and its potential to destabilise the entire supply chain process and the supply of medicines under the PBS.
This process has been described in eloquent detail by Neil Retallick, in his article “New landscape, new directions, new Government role in community pharmacy?”

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Clinical Pharmacist Roles Surging Ahead in US

Neil Johnston

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Neil Johnston is a pharmacist who trained as a management consultant. He was the first consultant to service the pharmacy profession and commenced practice as a full time consultant in 1972, specialising in community pharmacy management, pharmacy systems, preventive medicine and the marketing of professional services. He has owned, or part-owned a total of six pharmacies during his career, and for a decade spent time both as a clinical pharmacist and Chief Pharmacist in the public hospital system. He has been editor of i2P since 2000.

The Journal of the American Medical Association ran an article in its 13 October 2010 issue regarding an alliance forming up that included the traditional triad of health professionals – GPs, pharmacists and nurses.
It also highlighted that each sector was seeking a full seat at the health provider table - not just GPs as head with others following on in meaningless roles.
Recognition for pharmacists was awarded in the comment by the JAMA that stated:
“JAMA points to community pharmacists as a key resource to help bridge the gap between doctor and patient, particularly for patients treated by more than one specialist in an often disconnected and dysfunctional health care network.”

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The comment drew favourable support from all sectors of the pharmaceutical industry.
Similar comment was also made from the prestigious New England Healthcare Institute (NEIH), a think-tank involved with healthcare innovation.
This means that a powerful lobby is lining up behind pharmacy and that indicates a seismic “sea change” in doctor attitudes towards pharmacy.

The NEIH report calls attention to the prominent role that retail pharmacists can play in a more effective, cost-efficient and patient-centred healthcare system, plus the contribution they can make in disease and medication therapy management, also in patient adherence.
The report further notes that outcomes are best realised when pharmacists are working in collaboration with a team of patient-care professionals.

In other words, pharmacists working in close partnership with family-care physicians, specialists, nurses, nurse practitioners and health-plan sponsors with mutual respect being at the core.

These words have a familiar ring here in Australia, but they have only been heard within pharmacy circles to date. The Australian Medical Association has continually denigrated the role of pharmacists and continues to do so (see Pharmedia article this edition)

In the US this new direction, when measured against the old pharmacist-doctor turf battles of recent decades, is a striking change in tone.
Much of the last century of American medical practice has been dominated by a climate of professional stake-holding, with many doctors fiercely guarding what they considered a unique and inviolable relationship with the patient.
Pharmacists, many physicians asserted, simply were not qualified to dispense anything much beyond medications and basic counselling on their use, and had no business inserting them in that finely calibrated regimen of care developed between doctor and patient.
Doesn’t that sound familiar in an Australian setting?
And Australia does tend to follow on the heels of any US innovation or development.

How times have changed in the US – and quickly. There still may be lingering suspicion of pharmacy’s aims and abilities among a diminishing number of family practice doctors — along with a few lingering questions of professional turf and responsibility. But most primary care physicians are in dire straits, swamped by rising case overloads, third-party billing headaches and the enormous demands of a fast-changing health system in the throes of an information technology revolution.
They’re only too happy to have community pharmacists, nurse practitioners and other patient-intervention professionals as allies.

That’s particularly true in light of the growing body of evidence demonstrating just how much community pharmacists and nurse practitioners can bring to help doctors manage their caseloads, especially if working in a collaborative, team approach with shared patient data.
As the Journal of the American Medical Association made clear in an article published Oct. 13, pharmacists and nurses can help close the loop for a fully integrated link with patients and create a more “cohesive” network of care".

Indeed, said JAMA, “pharmacists and nurses could work with physicians to develop, implement and monitor drug regimens.”

Even pharma manufacturers could not fail to be impressed as they currently shift their marketing focus to an outcome-based regime.

The above follows on from an earlier article in JAMA dated February 2010 describing outcomes for the Polk County Contract for Care program

The result: After one year, the program showed improvements in key clinical measurements for enrolled members -- decreased glycosylated haemoglobin, a critical measurement of blood sugar levels, and lowered blood pressure levels -- while also reducing emergency room visits and in-patient hospital admissions.

Similar to the now infamous Asheville Project, the Polk County Contract for Care program scores the value of pharmacist intervention in disease management from a health outcome/cost savings standpoint.

Polk County implemented its Contract for Care program in February of 2005 and, at the end of the first year of the program, 477 members were enrolled and included in the analysis. Self-insured Polk County covers 8,500 Polk County employees and dependents.

The bottom line is that programs like Polk County Florida and the Asheville Project are a win-win situation -- an obvious win for the patient and a win for community pharmacy. Having pharmacists serve such a vital role in helping patients manage their chronic conditions not only further elevates the industry to the front lines of the healthcare debate but also further advances pharmacists as "physician extenders."

It illuminating that at least in the US pharmacists are now being valued in the clinical health system recognised as “physician extenders” by February 2010, and co-equals with other health providers by October 2010.
The driver is cost and outcomes, and pharmacists have been shown to be cost-effective and provide good outcomes when their services can be measured appropriately.

Unfortunately, pharmacists here in Australia have a way to go before we get the same recognition as our US counterparts.
Unfortunately, again, it is because of our divided effort in community pharmacy that has been for so long aggravated by short-sighted policies of the Pharmacy Guild of Australia.

The Medicare Locals that are just being set up in Australia may just provide the setting for Australian pharmacists to be funded and prove their worth.
Hopefully some of the efforts proven through Medicare Locals may be transportable to community pharmacies (as in the US). That would be a positive extension.

Early indications are that GPs will fight tooth and nail to control Medicare Locals, so we may see the early stages of these entities stagnate until our local doctors are given a bit of a “thump”, and asked to move over.
Meanwhile, this leaves Australia’s primary health care in an expensive mess, but hopefully staggering towards a good result.

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