Editorial
Welcome to the March edition of i2P – Information to Pharmacists.
You may have noiticed if you receive i2P by email, that we have simplified our mail out presentation.
This was because the code in our earlier version appeared to be too unstable to maintain, hence the simpler presentation.
Columns
Rollo Manning: Pharma-Goss
John Dunlop: Inside NZ
Loretta Marron BSc: Health Watch
Barry Urquhart: Marketing Focus
Harvey Mackay: Strategic Thinking
Mark Neuenschwander: I`ve been thinking about...Recent Comments
Past Editions
Volume 1 Number 1
Volume 1 Number 2
Volume 1 Number 3
Volume 1 Number 4
Volume 1 Number 5
Volume 1 Number 6
Volume 1 Number 7
Volume 2 Number 1
Volume 2 Number 2
Pharma News
Staff Writer: SIGMA Pharmaceuticals suspends share trading before release of revised earnings outlookHospital News
Health Politics
Pat Gallagher: Health Informatics - The State of the Nation
Peter Sayers: The Three-Ring Circus
Dr David More: e-Health IdentifiersEPublications
Independent Pharmacist Practitioners
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PDF version | James Ellerson |
James Ellerson is passionate about developing primary health care services across the spectrum of all health care practitioners working in a practical alliance, whether in an urbanised or a remote setting. | |
In the region where I practice, GP’s are reluctant to comply with a patient request for a Home Medication Review.
The stock standard phrase is “I can do that for you” and so in frustration a patient will turn to me, in a professional, or quite commonly in a social setting, and asks if it is possible for me to perform a review without the doctor’s involvement.
I am very reluctant to be involved, because a full review may not be possible if the patient is unable to provide test results, plus a full list of diagnosed conditions and a list of drugs taken prior to the current drug regimen.
All this with the known fact that the GP involved will not accept the results.
The danger, in these instances, is that high levels of professional friction may be generated.
But on the occasion when I can see a patient may benefit, and a reasonable level of information is available, I give in, if only to equip the patient with information to debate with their doctor.
There is no payment involved but there is often an insistence that my time should be reimbursed. On those occasions I nominate a “good cause” and suggest a donation be made to whatever level the patient feels comfortable with.
Mostly patients are simply looking for good information in respect of potential drug/drug interactions, and whether some of the effects they may be feeling can be attributed to the drugs they are consuming.
Also, whether there are any alternatives that can help in their conditions that they may be able to utilise to their benefit.
It is a pathway that can backfire because it will not necessarily win the doctor over to the patient’s cause.
Another direction is to suggest a patient find a more cooperative doctor and request a formal HMR referral.
On the other hand, a pharmacist is eminently suited to providing the abbreviated service illustrated (provided it is evidence-based) and if benefit is acknowledged by the patient, there is no shame in accepting a fee for this service.
We are told that we should be educating patients so that they are able to take responsibility for their conditions and treatment, and many wish to do this.
Many patients will simply enter into the process, looking over their shoulder in fear that their doctor may take exception.
When we talk about the development of professional services there is such a gauntlet to run from the medical profession, who aggressively defend their “turf” on any and every occasion.
Pharmacists are universally acknowledged as being under utilised, highly trained health professionals, capable of making a difference in the areas of self care and primary health care, and could do so if the thought of reprisal did not exist.
Therefore, this issue has to be faced head on by individual pharmacists willing to pioneer a professional service that is not dependant on reimbursement from the always pressured Pharmaceutical Benefits Scheme (PBS).
The few that are prepared to pioneer and undertake the fight will have to face the dramas in many instances, without official pharmacy support, for that is the case for the moment.
The Green Paper currently being prepared by the Pharmaceutical Society of Australia may give some insights and direction, so that when a White Paper finally emerges, there may be some support for professional services that can be progressively implemented.
The pioneers will initially have to find their market among the more affluent group of patients, but this market is a fairly extensive one, represented by retiring “baby boomers”, who have the wish to remain healthy and are proactive about it.
Once services are established and the government can see benefit, there may be a willingness for them to subsidise a service for those patients not able to pay on a private basis. But the service will have to be established ahead of any government subsidy, so independent pharmacist practitioners will have to put their capital at risk (like any other business) and fund their own initial research into what would form up into a viable professional practice.
I would never enter into a subsidised agreement with a government agency that dictated the price charged to a consumer. The lesson has been learnt through the evolution of the PBS system, and the reimbursement problems inherent in that system need to be avoided at all costs.
Pharmacist practitioners would also need political representation, and that will not be forthcoming through the PGA. The PSA remains a question mark for the moment.
The time is right, however, for like-minded pharmacists to form themselves into a political group and begin to define their future.
Independent practices can provide services from a pharmacy environment, from a GP super clinic environment, in a hospital or nursing home environment or within their own private environment.
Getting a group of pharmacists willing to undertake this direction, and I believe, preserve the core values of the pharmacy profession, will stimulate a positive and creative process giving pharmacists a hope for their future.
I actually know of one pharmacist who owns a non PBS pharmacy surviving on compounded and private prescriptions. On each afternoon, he conducts a consultative practice around his specialty, which involves supplementation of hormones of various types.
His evidence-based practice supports the notion that many lifestyle illnesses are indeed cause by hormone imbalances and insufficiencies.
Patients have to book up to six weeks in advance to have a consultation, and business is booming.
But he comes under fire from the medical profession no matter how ethically he runs his practice.
The weak link is when his patients are referred to a GP having had prior tests performed by an accredited laboratory, local GP’s will not accept the results, forcing patients to undergo a second set of tests through another pathology group.
To add insult to injury, many of these GP’s simply do not understand the principles of hormone supplementation and should not have accepted the referral in the first place.
He is also accused of exploiting patients because his charges for pathology etc are not subsidised by Medicare. Doctors point out the price difference to the patient but never disclose that government subsidies are involved for their service.
This type of GP is highly unethical, and there are quite a number in any location.
If a pharmacist was to carry on a similar activity against any GP practice there would be immediate and aggressive complaints by GP’s and cries of being unethical hurled at the pharmacist involved.
Because this particular pharmacist is transparent, and is providing a genuine benefit to his patients, there is a genuine patient-pharmacist relationship built, with a loyal and ever-growing patient base as a result.
It can be done.
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