Medicines That Matter – Drug Schedules Administered by Pharmacists

It’s taken a long time for pharmacy proprietors and their leadership body to take a good look and this sector of medicines and actually do something with it.
But at least it is being reviewed and that has to be a plus.
Another sector, with only a handful of scheduled items within it is the complementary medicines sector.
These items too need a review and the relatively safe section of clinical nutrition ought to be given some prominence.

Collectively, the above forms the nucleus of what could be described as integrative medicine, and this is the market worth prescribing and giving support to.
It is also a market that other stakeholders are looking at to promote as Self Care.

Now there is no doubt that pharmacy is the face of Self Care, but the problem has been that this activity has been entangled with the dispensary.
Self Care could only be dispensed between prescriptions and because of PBS prescription volumes, there was never enough time allocated.

Like clinical services, Integrative Medicine also needs to be separated and independently managed.
Promoted in this fashion, this sector will fill the gaps created by PBS commoditisation.
As David Quilty, in the PGA Forefront Newsletter states:
“One of the key underpinnings of Australia’s successful pharmacy model is the medicine scheduling system.  In particular, the S2 ‘Pharmacy Medicine’ and S3 ‘Pharmacist Only Medicine’ categories make a unique contribution to our health system and are highly beneficial to patients.
Community pharmacists are mindful of their responsibilities in relation to these medicines, and vigilant to ensure that the requirements of the schedules are upheld and applied in every transaction in every community pharmacy.”

While Integrative Medicine has been neglected, I am mindful that there has been an attempt to uphold the regulations, particularly S3.

When cough mixtures were restricted in sale based on someone’s version of safety, there was no such issue in Australia.
The issue arose simply because there were deaths resulting from unsupervised sales of cough mixtures in US supermarkets.
The laws were changed there and the bureaucrats here in Australia immediately imposed “harmonisation” and Australian pharmacists were actually penalised for doing their job properly.
There were no cough mixture issues in Australia.
Of course “efficacy” then became the spurious issue and the protests of pharmacists were simply set aside.

The point I am endeavouring to make here is that if there is to be a revamp of S3 as a component of Integrative Medicines, pharmacists need to become more militant around their expertise.
Why roll over because some bureaucrat can produce a vague argument that can overturn a completely pristine record by pharmacists?
And the PGA and PSA must mobilise in support – but the initiative must come from the grass-roots.
Otherwise, why have pharmacists?

There is another anomaly in our system also.
The NPS is providing education for supermarkets for the responsible sale of medicines!
How can this ever happen until the removal of alcohol and tobacco occurs, and how can it ever be responsible in a culture of constant sales growth with minimal oversight.
While some manufacturers see supermarkets as a means of increasing the sale of medicines, how can it ever be justified?

As David Quilty says: “Apart from the financial good sense for the pharmacy, appropriate recommendation of the S3 category additionally benefits patients and goes hand in hand with positioning pharmacy as a destination for health advice. Many S3 medicines are more effective than their S2 alternatives and, combined with pharmacist advice and education, may reduce the need for a costly and inconvenient visit to their general practitioner. Most importantly, they enable valuable pharmacist engagement with the patient.”

This will never happen in a supermarket, and our politicians need to ensure that it never will.

In recent publications of i2P we have highlighted the UK-based Lloydspharmacy “Health Bar” concept, where a specially fitted counter is located in the first third of a pharmacy, well away from any dispensary influences.
The bench is fitted with educational support (iPads accessing databases), and is also supported with specialist pharmacy staff and a pharmacist.
The concept pays its way and allows other activities such as skin care and pain management to be managed in conjunction with Integrative Medicine.
Locked drawers provide restricted access to S3 type medications.

Once upon a time we would have described this focus as a “profit centre” as indeed it is.
Research by Dr Alison Roberts from PSA has proven that it is quite profitable to create this particular focus, plus meet and greet to be visibly accessible by the general public.

David Quilty again comments:

“Despite the potential benefits of the category, there are signs that Pharmacist Only Medicines may be poorly utilised in some community pharmacies. Data extracted from the Quality Care Pharmacy Program (QCPP) mystery shopper program reveals that although pharmacists are aware of the products available in the S3 category, they are often poorly capitalized on, even when their use may lead to much better health outcomes for the patient.”

I don’t think we have to look too far into this category of activity to agree with the above statement.
However, properly structured, Integrative Medicine could generate sufficient income to pay the salary of a forward pharmacist attached to a health bar.
The decisions that have been avoided to this point are the actual retention of a pharmacist and the separation of a health bar from any dispensary influence.

Because it can represent a “business-within-a-business” it would be very easy to budget and produce separate profit and loss statements for that division of business.
In fact, I am sure Alison Roberts would appreciate receiving data in that regard to continue to build her evidence base.

“Over the past few months, the Guild Pharmacy Academy has been developing a suite of online training courses to assist pharmacies to formulate a plan to maximize the effectiveness of their S3 department, and therefore the beneficial impact on patients. This is part of the Guild’s focus on assisting the process of pharmacy transformation.
One of these online training courses, Pharmacist Only Health Solutions, has been released this week and is designed to assist pharmacists in improving outcomes for both their customers and the pharmacy business.
Pharmacist Only Health Solutions aims to unlock the potential of these medicines by addressing perceived barriers such as workload management, pharmacist referral procedures and staff training.
The course also provides effective change management solutions for pharmacies to help implement the recommendations and ensure their longevity.”

“To succeed in the face of price disclosure and mounting competition, pharmacies need to be well run if they hope to be profitable. They need to have clear business plans and clear measures of business performance. Capitalising on the opportunities provided by Pharmacist Only Medicines is an essential component of business growth. And it just happens to make great sense for the health system and for patients as well.”

i2P agrees with the sentiments expressed above by the PGA, particularly in regard to longevity.
We would also point out that it does not require a legislative framework to claim “pharmacist only” status for products.
They can be claimed by having them as part of a marketing plan.
That will only occur with commitment, focus and ongoing research and it is further suggested that suitable pharmacists may be found among the ranks of senior pharmacists, so that their years of experience, particularly in patient engagement, can be capitalised on.
The process used to be called “counter prescribing”.

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