EDITORIAL for Monday 23 November 2015

Welcome to this weeks’ edition of i2P (Information to Pharmacists) E-Magazine dated Monday, 23rd November, 2015.
Well, it’s now countdown to Christmas where traditionally forward planning and implementation processes are put on hold, and hopefully there will be a Christmas stimulus and  cash flow positive position at the end of the holiday season.

If forward planning is not engaged early in the New Year, delayed decisions will simply add to the problems of 2016.
Gone are the days when the change process has been a leisurely stroll – it is a state of running as fast as you can to keep up with changes that have already overtaken you – and it will be continuous.

The push for S3 advertising (and S4) is an ongoing pressure.
While there is a need to educate patients about potent drugs, is open advertising the best way to advance the cause?
If you are a manufacturer, of course, this is the only way you see to drive your market.
If you are a pharmacist, this may be perceived as an attack on a very successful regulation that has seen minimal harm emerge through the drugs controlled by pharmacists. This includes items like cough mixtures, which were taken out of S3 primarily because there were accidents occurring within the US system (and deaths did occur).
But in our evidence-based world this did not happen in the Australian system and there was no evidence to support this up-scheduling.
Yet it happened simply because the US based FDA created restriction, and Australian bureaucrats at that time simply followed suit without proper investigation.
The format of the Australian system currently appears more acceptable, but it has to demonstrate better balance between drug company interests and patient benefit.

Cost of access for patients is becoming an issue.
Some extreme potential was illustrated with the use of pholcodine – but this was with hospital surgery patients.
Surely hospital staff are capable of picking up on these items basically isolated to their specialised protocols?

Then we have those that claimed that no evidence existed to support that cough mixtures even worked in the first place.
With drug evidence being so tainted through Pharma influence, there is no reason to rely on purported evidence in the first place. So it’s back to practitioner experience.
What a mess!
Our lead article this week relates to the funding that NHS England has now found to fund support staff for GP’s.
Rather than fund an ever-increasing number of GP’s to look after patient welfare, they must utilise a range of other health practitioners to share the load.
In other words, a GP-led patient home is thought to be able to provide cheaper and better patient care.
Of course, being funded by government it immediately becomes ”managed care” and the pressure is then applied to provide this system for a fixed fee.
Why wouldn’t the GP’s delegate as much as possible to preserve a higher level of income for themselves?
Australian pharmacists considering a similar model of practice should carefully choose their way and ensure that appropriate contracts are negotiated for long-term protection.

We report the views of one GP educator who views this development as a GP being surrounded by a group of “wannabe” doctors, and gives them a title depending on origin.
Practice pharmacists become “Phoctors”; clinical nurses become “Noctors” and physician assistants become “Mocktors” (mock doctors).

Although the UK has long had exposure to collaborative interaction, it seems that it will take a long time to adjust the culture of the primacy of a doctor.
Why should Australia be any different?
The US has already demonstrated that this is the case, with change coming-but extremely slow in this activity.
Read: Phoctors and Docpharms where we look at this change process, also the attitude of some doctors wanting to be pharmacists (Docpharms).

Health Funds have been given freedoms to “front” for government in some decisions relating to health. This means that they will be blamed for any actions that adversely affect patients and their health practitioners (not government).
We have already seen Medibank being privatised and the loss of a range of hospital services that I would describe as cultural services.
Government has failed to change culture in areas such as rebound hospital admissions and patient falls within a hospital environment.
So the hospital is now not reimbursed for these occasions of service.
Guess who will eventually be charged for the shortfall?
Read: Health Fund Managed Care – Will it be a short-term positive or a long-term negative for Pharmacy
Also read in conjunction: Health Disruption to Health Care – by Health Funds and Major Investors .

Mark Neuenschwander is back and he reflects on a past Christmas and a mistake made in dispensing a medication with all of its ramifications.
As the holidays approach, it is timely to ensure that all of our safety systems are in place and all equipment is working to ensure Christmas can be enjoyed by all.
Read: I’ve Been Thinking – She should have been home for Christmas too

The OMNS (clinical nutritionists) are back and remind us that “A vitamin can act as a drug, but a drug can never act as a vitamin.”
They reiterate the use of niacin in the treatment of schizophrenia and for management of cholesterol and triglycerides.
Importantly, they also remind us that the cost of this vitatmin compared to mainstream medicines is very cheap and affordable.
It is obvious that patients are facing escalations in the cost of maintaining their health currently, and that pharmacists, by researching suitable evidence-based treatments for various conditions, can contribute to their wellbeing economically.
This would also provide a basis for designing consultations built around cost and wellbeing as a method of educating patients and transferring knowledge.
Read: A Constant Stream of Expensive Drugs

And we finish this weeks’ offering with a range of media releases from leader organisations:

Australian Pharmacy Council – Australian Pharmacy Council (National & NSW Releases)

PSA – PSA Media Releases – Eight Current Releases

ASMI – ASMI Media Releases – 1. Expert Panel Report 2. Codeine Decision Deferred 3. UK Self Care Week 4. Switch Environment & S3 Advertising

NPS – NPS Media Releases – Seven Recent Media Releases

Enjoy this edition of i2P and make a note of any content that could form part of your 2016 business plan.

Neil Johnston
i2P E-Magazine
Monday, November 23, 2015

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