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EDITORIAL for Monday 18 September 2017 – I2P

EDITORIAL for Monday 18 September 2017


Welcome to the current edition of i2P (Information to Pharmacists) dated Monday 18 September, 2017.
Frustratingly, health systems in almost every major economy of the world appear to be “unbalanced” and with a cost structure raging out of control.
Australia is no exception.
Even more frustrating is the role that is undertaken by a highly skilled network of pharmacists that seems to be forever undermined and under-valued- and almost invisible within the centralised health system itself.
Deliberately partitioned and commoditised on a continuing basis.
And we see this process in action as the King Review grinds to a disappointing end – just another political mechanism to deflect blame back on to pharmacy and an excuse to begin yet another costly experiment into micro-managing pharmacy.

Prior to the time when a centralised health system would be developed for Australia, market forces became the basic determinant as to who did what and how.
Within that market mix, pharmacists were always the first port of call by a patient seeking a broad range of generalised health advice and solutions.
Referrals were made for those patients requiring additional expertise to manage their health condition, mostly to GP’s.
A substantial number of patients found satisfaction within an accessible network of pharmacies and pharmacy’s reputation was earned in a positive fashion because of the high range of successful solutions provided.
This type of model also worked successfully in other major economies before they also embraced centralism.

Within a centralised health system, power and politics prevailed and market balance was lost in the sense that the medical profession engineered themselves to have a majority control over health policy decisions, and in turn, global pharma’s worked towards having a majority influence in medical practitioner policy formation.
The fact that both sectors required overcharging patients to fund the politics of control, has directly led to the unsustainability of the entire centralised health system.

Two enlightened countries have emerged and demonstrated value in the original  pre-centralised health model – a model proven by true market forces and a model driven through using pharmacists to manage the patient’s gateway into the health system.
Those two countries, Scotland and Switzerland, have recently trialled programs that involve pharmacists being funded to provide Self Care, a Minor Ailment Service and a Triage Service.
Each service having overlaps, and shaped by the format of each country’s existing health culture, with the Scottish system being the more developed model to this point, and the one most suitable for adoption by Australia.

The Swiss system, while being a newer development, has jumped in head first, embracing technologies and integrated communications between pharmacies and other health professionals.
It is also a development that could be absorbed within the Scottish system.

For a payment of 12 Euros ($AUD18) a patient can gain access to a telemedicine pharmacy infrastructure.
It is being offered through 200 Swiss pharmacies currently.
The service, called Netcare, gives pharmacists a gate-keeping role in which they triage patients by following one of 24 decision trees developed by doctors and pharmacists.
It allows people suffering from problems including cystitis, sinusitis, back pain and dyspepsia to receive quick and convenient treatment.

PharmaSuisse, the umbrella organisation for Swiss pharmacies, is managing the program and says that following a formal decision tree can lead to one of three outcomes:

* The first is that the pharmacist can give advice or supply an over-the-counter treatment to the patient, or both.

* The second is that the pharmacist asks the patient if he or she would like a video consultation with a doctor.
If the patient agrees the consultation goes ahead there and then from the pharmacy. Any prescription as a result of the consultation is faxed to the pharmacy for dispensing.

* The third, for urgent cases, is direct referral for a face-to-face consultation.
In all cases the pharmacist gives the patient a follow-up call three days later.

Billing for the whole consultation is carried out in the pharmacy.
There is a 12 euro fixed fee for the triage service, a 40 euro fee for the telemedicine consultation, and additional costs for any over-the-counter medicines or prescriptions.

Netcare is already judged a success with 3,000 services being provided since the pilot began in April 2012.
Data so far show that, using the decision trees, pharmacists have been able to help patients themselves in 80 per cent of cases, with no need for a physician.
A study to prove the efficacy and economic value of the service is ongoing.

Our lead article for this edition describes the Scottish model for a pharmacist gateway system.
In the wake of the King Review disappointment has spread to nearly every segment associated with the pharmacy profession and the pharmaceutical industry.
It has been a waste of resources and has generated mistrust, because of the conflict of interest issues that have arisen.
To such an extent, the Pharmacy Guild of Australia has produced its own plan for a community pharmacy future.
I2P agrees with their sentiments.
However, after a decade of investment, Scotland has developed a workable plan to transition pharmacists to a pharmacy care model, supported by government and associated health providers.
A good start in reducing the frictions associated with current Australian propositions. It positions community pharmacy as a form of “health hub”.
It is a sensible proposition and an Australianised version would certainly find favour with most segments of the pharmacy profession and collaborative health professionals.
Read: Scottish pharmacy – a public/private partnership that encourages pharmacist clinical development.

If a product or service is commoditised its value is always measured as being the lowest retail price.
Pharmacy care services therefore should never be designed as being commoditised or being able to transition to that state.

Commoditised components can form up as part of an innovative pharmacy care service.
It is the element of design that will decide a uniqueness, type and size of a premium that a patient consumer is willing to pay.
For longevity, part of a service design includes planning to prevent a major payer organisation (government or health insurer) from hijacking a majority control, because that will inevitably lead to a lower quality commoditised service.
Gerald Quigley starts a discussion on the proposition of value.
Read: The Race to the Bottom

“The science is settled”.
So say the people who promote vaccination as some form of extreme medical ideology.
“Scientism is settled” is a more accurate description of the manipulation of the science surrounding vaccines – and it is certainly “unsettling” to hear the dishonest claims that blare out in all forms of media.
“First do no harm” is the concept that underwrites all medical practice.
Australian vaccination policy is so poor and damaging, that it beggars belief that legislators can be so close to manufacturer sales objectives as to guarantee them a market through coercive legislation that involves simultaneous removal of patient choice.
The evidence supporting vaccine policy failure and its lack of safety is becoming so voluminous that it will eventually destroy the unnatural power alliance that desperately tries to hold it all together.
Read: The Safe Vaccine Debate – 1. Sacrificial Virgins 2. Dr Judy Wileyman Report: Newsletter#171 – Newsletter #172 – Newsletter #173 3. Over-Vaccination: Government-mandated over-vaccination in Australia

WHO has made a statement saying that cannabis should be decriminalised world-wide because existing laws cause health discrimination.
In Australia, patients are being actively discriminated against as police are instructed to enforce existing laws and close down “illegal” supplies, leaving critically ill people with no workable solutions for their health problems.
Flawed health policy generates bad laws and lowered community respect for policy and laws.
Yet again, Pharmacy is in a position to provide solutions very simply and simultaneously create opportunity for the profession to treat chronically ill patients efficiently and economically.
Pharmacy leaders need to be proactive in the regulatory area because other health professionals are actively competing to lock pharmacy out of any opportunity whatsoever.
Potential for pharmacists is found in the compounding of THC and CBD in specific ratios to match the best result for patients with chronic illness.
Further pharmacist potential also lies in using cannabinoids in harm minimisation programs involving opioid dependencies and as an adjunct for the management of pain.
Pharmacists also need to be active and have a voice in the regulation of these substances ensuring that maximum patient access can be obtained through the application of Schedule 3 of the Poison’s Act.
Read: Understanding Medical Cannabis – 1.Aging & Cannabis 2. A Lawsuit to Deschedule Cannabis 3. South Africa – Legal Cannabis for Personal Use 

There is something wrong with Australia’s agencies in the field of health regulation. They are increasingly beginning to resemble their corrupt US counterparts.
The fact that 17 natural medicine modalities are at risk for reduced access (through loss of government rebates) ought to be of concern for all as a loss of choice by consumers leads to a loss of quality and value within health services provision.
And Australian pharmacy is also in the firing line with the ridiculous suggestion that vitamins and complementary medicines become a “behind the counter sale”.
It is time our regulators became transparent and conflict of interest activities vigorously prosecuted.
Read: Orthomolecular Medicine News Service – They’re Back! The Pharmaceutical Shills

Arrogance should not be a part of pharmacy practice at any level.
It tends to creep in to a pharmacy business presentation, often at a point in time when it has reached a high level of achievement.
That allows for complacency to set in and consumer needs become less recognisable.
A pharmacy’s culture is always in need of review with its values perpetually tested.
Only then can arrogance traits be recognised and eliminated.
Read: Arrogance and business don’t mix

We finish up the current edition offering with media releases from three pharmacy leadership organisations:

PSA – http://i2p.com.au/psa-media-releases-check-your-lungs-for-world-pharmacist-day-2-pharmacist-generosity-supports-new-pharmacy-house/

ASMI – http://i2p.com.au/asmi-media-release-current-consumer-access-to-ibuprofen-appropriate/

NPS – http://i2p.com.au/nps-media-release-australian-prescriber-podcast/

And we remind readers to enter comment in the panel provided at the foot of each article.

Neil Johnston
Editor, i2P E-Magazine
Monday 18 September 2017


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