While you were asleep

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	Peter Sayers articles by this author...
Peter Sayers is vitally concerned about pharmacy professional practice - its innovation, its research and development, and its delivery to create an ongoing revenue stream. Delivery of healthcare is increasingly involved with Information Technology systems. All perspectives in IT must be considered for the impact on pharmacy practice and its viability.

In mid-January 2009 while everyone was either asleep or on holidays, a number of headlines appeared in pharmacy media almost simultaneously.
They were:
* “New dispensing charter on the cards”,
* “Pharmacists gain e.script incentive” and
* “PSA calls for more emphasis on professional services”.

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New dispensing charter on the cards

The new dispensing charter is a pseudonym for the Mirixa system, a system that has not been found to be fault free, both in terms of operation and actual outcomes.

In fact outcomes become distorted each time a patient goes to another pharmacy and there is a loss of that prescription data from a central source.

Perhaps there is a deal afoot to utilise the eRx database to overcome this deficiency. If so, is the government setting up a monopoly with the PGA at the helm?

I also wonder how a patient would feel when they know that we know when they have gone to an opposition pharmacy.

In the name of patient compliance the PGA has begun promoting in earnest to eventually harness funds that will become available from drug manufacturers and other interested parties, as they purchase patient compliance information through the PGA.

Global consultants have been telling drug manufacturers for some time that there is a huge gap in the market due to patient non compliance i.e. there is an opportunity to sell more of the same drug to the same patient.

The motivation here has more to do with Pharma profits rather than patient wellbeing.

The system is being reported as being implemented in every pharmacy in Australia using the Fifth Community Pharmacy Agreement negotiated by the Pharmacy Guild with the Federal Government.

According to details of the agreement currently released, a new Prescription Commitment will compel pharmacies to issue every patient filling a prescription with a leaflet tailored to the patient and the drug dispensed.

The leaflet will include consumer medicine information (CMI) for that drug, information on premium free products and a patient’s compliance score for chronic disease medications derived via dispensary systems.

This sounds like a form of civil conscription and normally one would expect political organisations like the Pharmacy Guild and the PSA to fight like mad to prevent this from happening.

However, there is a conflict of interest here, a process we reported on some years ago when the PGA first started to get involved with the ownership of IT systems.

Have pharmacy proprietors become so “dumbed-down” that they are now simply led by the nose to dance to an agenda that is unsuitable for both pharmacists and patients?
And how will they know they are getting the best deal with other software vendors virtually shut out.

The government is quite happy to have the PGA do its “dirty work” for it, and also have the ability to deliver political messages at no cost to them through the same system.

The PGA executive is quite happy to tap a new vein of enrichment at the expense of its members, and continue living the good life

PGA members are yet to wake up.

But what about non-PGA members?

Are you all happy with being conscripted down the Mirixa pathway in the name of patient compliance being a good thing?
Where is your professional discretion to decide what is is best for your patients?

Pharmacists gain e.script incentive

This one is a real can of worms.

In making the announcement to give pharmacists 15 cents per prescription for accepting e.prescriptions, the incentive for using PBS online of 40c per script was dropped.

On the surface, the loss seems to balance out at 25c per script, but that is not the case.

Not every script will be able to be delivered electronically because GP's at this stage are not cooperating by transmitting original scripts.

However, pharmacists can complete about 80% of their e-script work without the doctors
The doctors are slighted because their Medisecure system has not been offered any rebate for delivering e.prescriptions nor will the e.Rx system talk to Medisecure.

I can't see this monopoly situation involving the PGA, holding up for any extended period.

Workarounds will be looked at to accommodate the doctors and that will tend to escalate costs.

eRx sucks up all PBS prescriptions from pharmacy member desktops.Already the database gloats that it holds 7.5 million undispensed scripts

Expect ongoing disruption to occur as doctor organisations confront the PGA and government. 

Any collaboration here is going to be icy so I hope that the PSA has distanced itself from the PGA so that its new-found doctor collaboration is seen to be separate and exclusive, and genuinely involve positive benefit for both sides.

Note that patient benefit has entirely disappeared and replaced with doctor/pharmacist/government financial greed and control – but only for a small number who hold the control.

PSA calls for more emphasis on professional services

 I get really concerned when I see items like this one, where it seems the PSA has been left at the altar once again.

There is a crying need for pharmacist practitioners to be funded independently from a pharmacy.

Without a level of independence and certainty of funding, you will not attract the entrepreneurs capable of building professional practices.

Under the new measures proposed in the Fifth Agreement, the Quality Care Pharmacy Program will become more rigorous and will be supported by a new pharmacy practice incentive, which will include  medication management services such as helping patients take their medicines consistently and improvement health literacy.
Hardly earth shattering new services. And will incentives cover the real cost?

In this month’s edition of i2P, the Pharmedia column suggests funding built around a service allowing patients to disengage with certain medication (e.g. proton pump inhibitors) where funding can occur from the savings within the PBS system.

This would involve a series of consultations and a switch of treatment to one involving less stress on a patient’s nutritional status (see the Pharmedia column for full details).

The 5CPA agreement will also initiate medicine use reviews to help pharmacists discuss medication usage and compliance with patients plus produce a patient medication profile.
Surely this process can be extended to cover additional consultations that may be required?

2010 looks set to be another year that will waste valuable pharmacist human resources by not having appropriate professional services or infrastructure in place, while simultaneously having to deal with top down IT systems that always end up being expensive in time and software costs - and more importantly - they do not work.