Welcome to the December edition of i2P-Information to Pharmacists.
As we wind down in 2013 for the holiday period we will be filing some updates, but at a little more leisurely pace.
Where has the year gone?
Certainly the rate of change for 2013 has been more than hectic and there has been little time to organise thoughts and set appropriate directions.
This is the season for hard negotiations for the 6CPA but there is little left to squeeze.
Pharmacy has had the equivalent of bariatric surgery.
Government has taken it all, as usual.
As current price changes work their way through the pharmacy cash flow cycle, for some there will be insufficient- and heartburn.
Crunch time is that there will be more bankruptcies over 2014.
Media reports that some pharmacies have received free shop refits as a form of payment for purchasing a specific generic drug range is certainly not obvious, as the average pharmacy is in need of some renovation or repair and looking a bit jaded.
Volume 1 Number 1
Volume 1 Number 2
Volume 1 Number 3
Volume 1 Number 4
Volume 1 Number 5
Volume 1 Number 6
Volume 1 Number 7
Volume 2 Number 1
Volume 2 Number 2
Volume 2 Number 3
Volume 2 Number 4
Volume 2 Number 5
Volume 2 Number 6
Volume 2 Number 7
Volume 2 Number 8
Volume 2 Number 9
Volume 2 Number 10
Volume 2 Number 11
Volume 3 Number 1
Volume 3 Number 2
Volume 3 Number 3
Volume 3 Number 4
Volume 3 Number 5
Volume 3 Number 6
Volume 3 Number 7
Volume 3 Number 8
Volume 3 Number 9
Volume 3 Number 10
Volume 3 Number 11
Volume 4 Number 1
Volume 4 Number 2
Volume 4 Number 3
Volume 4 Number 4
Volume 4 Number 5
Volume 4 Number 6
Volume 4 Number 7
Volume 4 Number 8
Volume 4 Number 9
Volume 4 Number 10
Volume 4 Number 11
Volume 5 Number 1
Volume 5 Number 2
Volume 5 Number 3
Volume 5 Number 4
Volume 5 Number 5
Volume 5 Number 6
Volume 5 Number 7
Volume 5 Number 8
Volume 5 Number 9
Volume 5 Number 10
Volume 5 Number 11
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.
Slowly, the opportunity for pharmacist clinical services is opening up.
Just this week the US Centre for Disease Control (CDC) announced a project to train pharmacists and retail store clinic staff at 24 rural and urban sites to deliver confidential rapid HIV testing.
CDC will use the results of the pilot effort to develop a model for implementation of HIV testing in these settings across the United States. The project is part of CDC’s efforts to support its 2006 testing recommendations, which call for all adults and adolescents to be tested for HIV at least once in their lifetime.
Slowly, the opportunity for pharmacist clinical services is opening up.
“We know that getting people tested, diagnosed and linked to care are critical steps in reducing new HIV infections,” said Kevin Fenton, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. “By bringing HIV testing into pharmacies, we believe we can reach more people by making testing more accessible and also reduce the stigma associated with HIV.
In Australia, most HIV patients prefer to visit sexual health clinics in public hospitals to receive treatment.
This is primarily because most of these patients feel less discriminated against and more supported, in a public hospital setting.
Pharmacy plays an important role in respect of privacy, with some hospital dispensaries setting up secure storage and access for prescriptions and other records that can only be accessed by specific HIV pharmacists.
Large staff numbers in public hospitals make it a given that a percentage of them will be HIV affected.
Very few HIV patients feel confident that hospital level security is available to them in community pharmacies and you only have to take an unbiased look at the average pharmacy to understand the reasons why.
The CDC have recognised some strong positives about community pharmacy to place HIV testing in those environments. They are:
* Ability to reach more people.
* Testing is more accessible.
* Reduction of stigma by creating a primary care environment for HIV along with all other lifestyle illnesses.
CDC estimates that 1.1 million people are living with HIV in the United States, yet nearly 1 in 5 remains unaware of the infection. In addition, one-third of those with HIV are diagnosed so late in the course of their infection that they develop AIDS within one year, missing years of opportunities to receive life-extending medical care and treatment, and potentially reduce transmission to partners.
However, Australian pharmacy could miss out on this service opportunity simply on the issue of the lack of privacy.
One would have to wonder about the number of other potential pharmacy patients available for a range of other conditions who are also privacy-sensitive. Some are vocal on this issue, but I would be more concerned by those unknown patients who simply “march with their feet” rather than make a complaint
If a survey was conducted around the patient type that would demand “gold standard” privacy, it would undoubtedly be the HIV affected patient.
If Australian pharmacies want to participate in clinical services such as the HIV testing service, it is obvious the first priority must be the redesign of clinical space so that:
* They are differentiated from all other “spaces” within a pharmacy and be “gold standard” for privacy and discretion.
* They are designed to be completely private for discrete conversations and interviews at varying levels of privacy.
* Special “noise-masking” applications must be used and their use being made known to all patients to promote privacy confidence.
i2P has published a recent article on the design of clinical spaces that can be found here. http://www.i2p.com.au/article/pharmacy-clinical-spaces
Community pharmacies and retail clinics, with their convenience and easy accessibility, could play a critical role in ensuring more patients have access to an HIV test. Data suggest that more that large numbers of people enter pharmacies every week, and an estimated 30 percent of the population lives within a 10-minute drive of a community pharmacy. Compared to health care settings and conventional HIV testing sites, these locations may provide an environment that is more accessible to persons who may be anxious about seeking an HIV test.
“Our goal is to make HIV testing as routine as a blood pressure check,” said Jonathan Mermin, M.D., director of CDC’s Division of HIV/AIDS Prevention. “This initiative is one example of how we can make testing routine and help identify the hundreds of thousands of people who are unaware that they are infected.”
The CDC is establishing a two-year pilot study and will provide training for staff in community pharmacies and retail clinics in 12 urban areas and 12 rural areas with high HIV prevalence or significant unmet HIV testing needs. Training will focus on how to deliver rapid HIV testing and counseling and link those who are diagnosed with the virus to care and treatment.
Based on lessons learned, CDC will develop a comprehensive toolkit that pharmacists and retail clinic staff from around the country can use to implement HIV testing.
Obviously that toolkit in some form, will eventually become available for Australian pharmacists.
Given that the US pilot study will take two years to complete, this timeslot can be utilised here in Australia to develop optimum clinical spaces (not just counselling rooms). Those spaces can be immediately utlised for clinical services that can be delivered now.