Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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A New Clinical Opportunity on the Horizon

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.

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.

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“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.

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.

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