Editorial

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Welcome to the May 2012 homepage edition of i2P-Information to Pharmacists. Rollo Manning has been having some time out having staples removed from the site of his open heart surgery.He is now at home recuperating in Darwin, having arrived home last Friday, beating a cold and hasty retreat from Canberra.We all wish him a speedy recovery and hopefully, he will be fit enough to contribute by next month.
This month, Pharmedia discusses the toll that is taken when someone complains about you to an authority without good cause. Well, the good news is that you can now take action to protect yourself if such a complaint is made, and that may even include action for defamation. Read about a recent case involving two doctors, with Mark Coleman drawing on personal experience to illustrate.

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Pharma-Goss - HMR/MMR – an opportunity to be gained

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Rollo Manning has experienced pharmacy practice from all sectors of the industry – retail, administrative, policy and remote Aboriginal practice. He spent 10 years with Glaxo Australia and was the first Director of Public Relations at the Pharmacy Guild National Secretariat in Canberra. He has also held the position of Pharmacy Policy Officer for Territory Health Services in Darwin. Rollo is currently a Consultant working in his own practice with remote Aboriginal communities, in Northern Australia.

This writer is impressed by the HMR/MMR process and was never more surprised than finding out the rigorous nature of the accreditation process that needs to be undertaken for a pharmacist to become eligible to undertake the tasks, report and claim the $196 through Medicare.
The immediate reaction is “what are we trying to produce – an academic genius that could mix it with the best of pharmacologists” rather than a pharmacist able to look at a medicine taking situation - assess its quality and make recommendations to a doctor on where changes might benefit the patient.

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40 years ago the prescription book was meticulously indexed so that every patient who had a script dispensed could be referred to quickly if a review was to be done of their medication intake. This was of course before the days of high-powered ACE inhibitors, Beta blockers, SSRIs and PPIs. None the less the pharmacist was expected to be able to give a doctor a list of a person’s prescribed medicines and a comment on the appropriateness of it for the patients’ conditions. There was no Medicare then or any remuneration for the effort and yet it took hours of an apprentice’s time to do the indexing and in so doing start to become familiar with the various prescriptions dispensed.

At present the process is rigorous, demanding, detailed and highly academic for pharmacists who are going out to review a persons’ prescribed medication and over the counter remedies with a report being done for the prescribing doctor who requested the intervention. References have to be given for claims made and it is unclear if this is for the benefit of the AACP assessor or the doctor requesting the review. It is an arduous task collecting all references and for what end?

The pharmacist is up for many hours of detailed study and research to produce a report that needs to be questioned as to its relevance to a busy General Practitioner who just wants to know whether the regime prescribed for the patient is okay or not.

Is the doctor really going to read it?

And what comes out as the final result of this effort by the 913 Accredited Pharmacists around Australia that are listed on the Australian Association of Consultant Pharmacy  website.

Let’s look at the number of Accredited Pharmacists[1] by State/Territory and the number of HMR/MMRs done on average per Accredited Pharmacist:

The total number of reviews done, according to Medicare data[2] is as follows with the average per Accredited Pharmacist in a 12 month period shown in the right hand column together with the average number per week - the figure is rounded to the nearest whole number and is based on 48 weeks work a year.:

Given that the Accredited Pharmacist now receives $196 per review this would amount to $22.4 million on present day terms. An average per pharmacist of $24,582 per year. This is hardly an income for a professional practitioner and a number of questions are raised from this analysis such as:

1. The uptake is not considerable and it needs to be explained as to why the accreditation process is so onerous and whether a more relaxed process would allow more pharmacists to be accredited?

2. The financial return seems generous enough so why are not more HMR/MMRs being done – what are the barriers?

3. Is the promotion from the Divisions of General Practice adequate such that GPs understand the HMR process and how to make it happen?

4. Is there correlation between the number of reviews done and the presence of a pharmacist HMR promoter at the Division of General Practice?

5. Is the Medicare ordering and claiming process for the GP too complicated and if so how can it be simplified?

6. Is the time taken to do a review fairly remunerated through the Medicare benefit payment?

7. How could more pharmacists be encouraged to undertake the accreditation process and how many are put off by the onerous study regime at present required?

These and no doubt other questions need to be asked and the answers made known to all so a better understanding of this excellent professional clinical process can be gained and more HMR/MMRs done in Australia.

There is no better way to promote the value of the pharmacist in primary health care – until you are out there doing it no one will know what you can do – just do it – now!

Comments welcome to Rollo Manning, PO Box 98 Parap NT or rollom@iinet.net.au or 0411 049 872

[1] Download from http://aacp.moodle.com.au/mod/folder/view.php?id=834 on 22 January 2012

[2] Medicare data 1 July 2010 to 30 June 2011

[3] Based on 48 weeks in a year working and dividing the average number of number of HMR/MMRs done per person by 48 to get the weekly average.

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