EDITORIAL for 23 February 2015

Welcome to this weeks’ i2P (Information to Pharmacists) E-Magazine dated 23 February 2015.
This week we have some very important reference material that has coincided with a PSA(NSW Branch) initiative.
We were initially looking for signs that funding for clinical service pharmacists might come from the Australian government.
Nowhere could we see anything positive!

In fact, with the recent release of the Consumer Health Forum’s (CHF) submission to the 6CPA we were interested to note that CHF actually recognises a role for clinical pharmacists, recommends that the Professional Pharmacists Association be their representative negotiating body for them, and further recommends funding for pharmacist services should come through the MBS funding arrangements.
Nothing wrong with that and i2P finds full agreement there.

But pause here while the medical establishment now fights “tooth and nail” to delay the inevitable and unfortunately, disrupt the development of new initiatives from pharmacy, nursing and allied health, in respect of primary health care.
The AMA is definitely out of step with other health professions, but many would claim this has always been the norm.
i2P research indicates that many patients are becoming highly dissatisfied with their doctors and we will be publishing that evidence shortly.

In pondering where pharmacy services could have a major impact (and thus be self funding) we were attracted to the rebound rate of hospital patients within a 30 day time-span, post discharge.
And the cost!

Given that hospital care is the most expensive area of healthcare cost, and that rebound patients are even more expensive in the intensity of their treatment and their longer term of stay, this, to i2P looked like a good source of funding.
Although pharmacist intervention at the point of discharge has been identified as one to be supported, hospital administrations have consistently not supported pharmacy propositions.

So we researched the US experience because there was little to note in the Australian equivalent.
In the US, and more gradually in Australia, the focus is on paying for outcomes and penalising poor performances through reducing health insurance claims by health professionals or institutional rebates.
Payer organisations are driving the efficiencies that for so long have defied logic, because they seemed so embedded within health systems, with the appearance of calcification.

But change is occurring and health payers are discovering how well pharmacists help to efficiently trim costs, to the extent that pharmacists are fast becoming “the flavour of the moment”.

i2P is of the opinion that the budget available for clinical pharmacists at the state level is such that it is large enough to develop an outreach into community primary health care systems.
This is why PSA  in its new campaign, must look beyond hospital rebound patients and develop programs that will link in with community pharmacies.
Perhaps medical cannabis may become an extension of note because of its propensity to treat neurological pain – one of the fastest growing sectors in primary health care and another entry point identified by PSA.

It is in the area of clinical services in community pharmacy, that the past failures of policy and planning by PGA are coming home to roost.
Despite its prominence in funding negotiations in the PBS arena, it has failed spectacularly to work a forward solution to the problem of a PBS product that has been in decline for the last 20 years, and that has now reached the bottom of its life cycle.

“Ask your pharmacist” is a start, but what is there in a developed format that is recognisable to health consumers?
Why haven’t “they” been asking pharmacists in significant numbers for the past 20 years?
Simply because PGA executive over that time saw clinical services as a threat – a means of reducing the income of  community pharmacies – something that had to be stopped!

State government hospital budgets are best placed to foster clinical service pharmacists and be the initial driver for primary health care initiatives through these pharmacists.
The Australian government must eventually get around to funding pharmacist services because the evidence that will exist for their justification will overwhelmingly come from the hospital rebounds and primary health initiatives.
That PSA have identified an entry point opportunity goes to their credit.
One further modification needs to be considered in advance and that is whether these pharmacists should be direct employees of hospitals or be contracted to professional pharmacist practices where multiple pharmacists and their skills might find a better home. The option needs to be negotiated.

The articles researched for clinical services are titled “Downstream From Hospital Re-admissions” and “Precision Medicine – Pharmacy needs to get a move on”.
Associated with these articles is a further topic titled “The Huge Information Disconnect in Primary Health Care”.

Other articles of interest include “Time for common sense and good science to prevail in the Australian vaccination debate” , “Pharmacist Jobs Destroyed by Automation?” , “Seth Godin and The Productivity Pyramid” , “Good news! A compound in red wine may help prevent memory loss”.
Plus media releases from PSA (including the PSA (NSW) release) and NPS media releases.
A great read for this week and it is recommended that articles of interest to you should be bookmarked or printed.

Neil Johnston
23 February 2015

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