Editorial

From the desk of the editor

Welcome to the May 2013 edition of i2P - Information to pharmacists.
Economic turbulence seems to now be arriving in Australia with forecasts of high inflation rates, which also means high interest rates following on.
This type of economic forecast also means that banks will be more fractious with their borrowers. They are already offside with pharmacy due to the high level of bankruptcies over the past two years.
There is a pent up demand for a general wage increase for pharmacists impacting at a point in this month where pharmacy gross profit generally, is in decline.

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Pharma & Wholesaler - Invading Community Pharmacy

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Neil Johnston articles by this author...

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.

Over the past four years, i2P has been promoting the concept of “Pharmacy-in-the-home”, the definition of “home” being where a patient actually lives (private home, nursing home, hostel etc.).
More succinctly, the concept of the development of a mobile pharmacy health service has been a project in progress.
Understandably, the concept of a mobile service has also caught the attention of mobile phone manufacturers and their “app” developers, with the latter starting as an interesting innovation, but now turning into an innovation flood.
There is no doubt that pharmacy must change its model of health delivery and become proactive on behalf of patients - to be mobile and have diversity in health programs and individual services

Simultaneously, mobile phones have become “smart” and a whole new health segment has been born (known as mhealth).

In a recent article featured in the online publication “Chemist & Druggist”, discussion centred on the content delivered from the Conference of the European Association of full-line wholesalers, held in Lisbon. The following is an excerpt:

Bricks-and-mortar pharmacies will be ‘last resort’ by 2020

Bricks-and-mortar healthcare facilities, including community pharmacies, will serve only as a last resort by 2020, the head of Vodafone's mobile health services has warned.

Rising healthcare costs and technological innovation could mean healthcare services will be provided outside of traditional facilities whenever possible, Vodafone head of mHealth solutions Axel Nemetz told the annual conference of the European Association of full-line wholesalers (GIRP) in Lisbon last week (June 4).

This could bring with it opportunities for pharmacy, he claimed. "Opportunities around home care, but also opportunities around assisted living. The solution today is to bring the patients out of the hospital as much as possible so they can be remotely monitored."

Approximately two years ago i2P alerted Australian pharmacists to a paper produced by Price Waterhouse Cooper (PWC) that summarised future directions for the Pharma industry.
It foreshadowed that control of the supply chain would be necessary as a means of maximising drug prices and establishing a direct distribution channel was essential to a manufacturer’s survival.
Shortly after the release of that paper Pfizer moved to direct distribution in the UK and then Australia.
The PWC consultants also noted the precarious position that direct distribution created for wholesalers and pharmacies.
The impact Pfizer alone had on full line wholesalers in Australia was significant.
However, PWC also predicted that pharmacy wholesalers would move into their own client’s market place and begin to provide clinical services to bridge gaps.
It is for this reason that i2P has been promoting “pharmacy-in-the- home” as a service, but also developing a clinical wing and charging a fee for a range of new services.
Some pharmacies have begun to look at such a service delivery, but few have reached a significant offering as yet.

Reflect on the following pressures, that are now self-evident:

* Supermarket-type pharmacies have expanded and have a significant market share.

* Pharmacy ownership and business structure remains unwieldy- pharmacy companies are unable to recruit directors with requisite skills (legal, accounting, marketing to name a few), because of the legal restraints on pharmacy companies.

* Doctor groups will continue to suppress any development and growth in pharmacy clinical services

* Wholesalers have already developed models of retail pharmacy that could rapidly expand to compete against community pharmacy should the opportunity occur e.g. Priceline has a model that works within a pharmacy or independently. This model could easily embrace professional and clinical services with minimum adjustment (an example is the vaccination clinic with nurse practitioners administering doses (not pharmacists).

* PBS reforms have gutted community pharmacy and bankruptcies are rapidly increasing – a phenomenon that pharmacy has never seen before.

* Manufacturers such as Pfizer have created upward pressure on purchase prices of drugs and other manufacturers are set to follow waiting for pharmacy resistance to reduce further, to minimise their exposure to damage.

* Pharmacy leadership organisations appear stuck in the quicksand of all the above events and the inertia suggests that they have no plans to extricate their members in the short (or long) term.

Other conference items included the potential for wholesalers and pharmacies to share back-office costs and processes

“The conference also heard from Eero Hautaniemi, CEO of Swedish pharmacy chain Oriola-KD, who warned delegates that when the pharmacy market changed it was no good sticking to practices that were no longer valid. But he was optimistic about the impact new technology could have on the pharmacy business model if it was utilised effectively. "In this kind of environment, where the market is changing fast, we have found that e-health services are a good way to bring value to pharmacy and increase efficiencies," he said.”

There has not been a great deal of web presence development for community pharmacy.
What exists is mostly confined to the retailing of cut price goods and services.
There has been little development in the delivery of professional services through the Internet and with the plethora of electronic applications emerging it is possible to manage a range of patient biometrics from a remote location, as well as from pharmacy premises.

This could provide a gateway into a patient’s home that could create value with the addition of new services or allowing other programs (possibly developed by wholesalers and manufacturers) to integrate with.
Patient monitoring and communications opens up a vast opportunity for pharmacists to partner with nurses and GP’s and provide a “pharmacy-in-the-home” program that can be progressively developed and integrated within your pharmacy website.
The following is an example of one of the new “wearable sensors”

Illustrated is a sensor that can be unobtrusively fitted to be wearable, as part of a patient’s clothing.
It can provide real-time monitoring 24/7 for patients with a critical need or alerts for out-of-reference situations that may flag the potential for a medical disaster.

As governments try to stem the tide of aged care costs, devices like the above will enable patients to be monitored, and possibly treated in their own homes.

With pharmacists available to simplify and deliver the new technologies plus provide the communication to the areas that need the information and alerts, it is not hard to envisage that with a breakthrough of the inertia that currently exists, a bright future is available for the taking.
What are your plans?

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