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Volume 2012 Number 1

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Pain Management and Analgesic Sales

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	Neil Johnston articles by this author...
Introducing current ideas, perspectives and issues, to the profession of pharmacy

With the changes occurring restricting the sale of analgesic products within pharmacies, there has not been a great deal of discussion as to how best to handle these changes.
It has been said that the new processes impact severely on the pharmacist’s workflow.

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PHARMACISTS HELPING IN CHRONIC PAIN MANAGEMENT

Pharmacists can play a pivotal role in assisting patients with chronic pain to access support services and also to be a regular point of contact for patients, the Pharmaceutical Society of Australia says.

PSA Queensland Branch President and Member of the National Pain Summit, Dr Lisa Nissen, said pharmacists were caring and informed health-care professionals who were highly trained to assist patients in managing their condition.

“Chronic pain is a significant issue in the community with many patients unable to receive adequate support and care for their condition,” Dr Nissen said.

“Some of this is due to a lack of access to appropriate medical care and pressure on an already overstretched health system.

“However, a significant component of the problem relates to the lack of understanding of the impact of chronic pain on a patient’s health and wellbeing and access to services to support patients in the management of their chronic pain conditions.”

Dr Nissen said the National Pain Summit held earlier in the year proposed a footprint for how the country could move forward.

This included considerations for both the medical profession and the community more widely in better addressing pain management.

Dr Nissen said support services like the Australian Pain Management Association’s Pain Link Helpline (1300 340 357) and Chronic Pain Australia’s National Phone Information and Support line (1800 218 921) provided an important service for not only pain sufferers, but also for the health professionals caring for them.

“We should not undervalue the impact we can make for these chronic pain patients who are often mostly ‘invisible’ within the community,” Dr Nissen said.

“One example is the Home Medicines Review where patients can sit down in their own home with an accredited pharmacist who reviews their medications and helps them to optimise their pain management regime.

“Pharmacists are accessible, trained and ready to assist these patients.

“In conjunction with services like the support line and the help line, the professional services and advice provided by pharmacists can make a real difference in helping chronic pain sufferers manage their condition.”

Mark Coleman comments:

The problems within a pharmacy environment that are created by this issue are considerable.
In my mind, there are four streams of patients that exist:

(i) patients suffering from acute pain;

(ii) patients suffering from chronic pain associated with another condition e.g. osteoarthritis;

(iii) patients who may have become dependent on analgesics through medical mismanagement;

(iv) patients suffering from neurologic pain.

So the triaging of each patient stream is the first essential plus a plan to be developed to handle each patient stream.

I guess it is time for pharmacies to make an investment decision – and fairly quickly.

Do you want to retain the analgesic market or not?
If retention is the aim, then a pharmacist will probably be needed to be recruited to perform all the clinical/counseling roles, including pain management, in addition to the existing number of employees.
A business plan needs to be constructed around the provision of such a service to estimate what sort of return an additional pharmacist would generate.

Ideally, this pharmacist would record all the recommendations made from a separate area  segregated from the existing work flows.
This does not need to be a separate room, but it does need an area with sufficient partitioning to create a level of privacy, particularly in regard to conversations.
Patients are more easily enticed into this form of open office rather than an enclosed room.

It may well be possible to manage clinical patients within the dispensing mix without adding additional pharmacist hours, but I think you are only putting off the inevitable.
By providing a properly resourced clinical program it will definitely lift medicinal sales and services, including dispensing and increase your market share.

However, the greatest benefit is that it allows a pharmacy practice to expand its range of services and professional product range – and that generates consumer confidence.
Allowing closer pharmacist contact with a patient always improves business and goodwill, and allows a pharmacy to generate a professional atmosphere.

Additional investment will also be needed for electronic equipment to record these transactions.
Apart from a computer, a simple scanning device is needed to capture Medicare data (or the new patient identifier when it comes along) or a driver's licence, plus be able to read a product bar code.
That will quickly and accurately create a primary record.
If this record can be uploaded into the dispensary computer at regular intervals, or be able to be networked online with the dispensary computer then you are able to streamline the recording of details without interrupting the dispensing flow.

You may even be able to integrate your own smart card containing the range of details needed to manage your patients with efficiency. Build enough value into your own "patient card" and you will surely begin to concentrate professional business in your pharmacy

The value-adding to this activity could also be increased by integrating preventive medicine programs, including the use of evidence-based nutritional supplements.
This could also expand into anti-aging medicine and aged care markets.
The anti-ageing segment may require a small compounding area while aged care may need development of a full scale assistive-living program.

And while you are thinking about it an outreach into a “pharmacy-in-the-home” initiative could also extend your reach into home medicines reviews or any variations thereof.

This would require an Internet back up and some form of secure electronic communications system.

Think about the “pharmacy-in-the–home market” – a captive market not dependent on parking areas or competitive shopping malls where you could introduce catalogue campaigns, loyalty incentives etc. to an increasing number of retiring “baby boomers”.
Setting up this type of service gives you a “hands-on” approach with your patients that would rival one of your other professional competitors – community nurses. Or by thinking creatively, you create a structure to absorb them.

So far I think we have covered a market that could expand for the next 30-50 years. With the proper infrastructure in place you can leave your competitors at the starting post – and you don’t have to be a warehouse discounter to achieve market dominance.

Think further about the type of pharmacist you may consider employing, and in what form.
If the pharmacist is structured as a service company you may have now developed the “arms-length” required for that pharmacist to become a prescriber without a conflict of interest.
The type of pharmacists utilised for this service may need to be a mix – senior pharmacists willing to work shorter hours plus recently graduated pharmacists willing to accept mentoring from experienced pharmacists in the clinical field (including hospital pharmacies).

Primary Health Care Organisations are now on the horizon and what better way to link community pharmacy in with this type of facility by utilising a community clinical service.

We have wasted a lot of time and the people charged with developing clinical systems and services have either been “asleep at the wheel” or in some cases have been short-sightedly obstructive.

Time to get moving!

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