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Tick tock

by Elixir on May 30th, 2010 - Anecdotes, From the frontline

pharmacy clockI’m playing a bit of a waiting game today for something that may not actually happen…some may call this “wasting” rather than waiting but if things turn out as hoped it will make it all worthwhile. If not, it’s miserable outside and there’s not much more I would have been doing anyway other than rocking in a corner whispering “sun…sun…” over and over again.

As I wai(s)t(e)  out the day, I couldn’t help but think back to the most asked question in a community pharmacy  – how long will this take?  Perhaps second only to  – will my insurance cover this?  Questions I grew loathe to even hear let alone answer, seeing as how the most common answers were 1. two to 45 minutes and 2. I have no  f***ing idea.

A couple months ago there was a  Press Release from the UK Office of Trading that said that partial liberalisation of the pharmacies market has brought significant benefits for consumers, including shorter waiting times, a greater choice of pharmacies and extended opening hours…and has improved access to lower-priced over-the-counter medicines. Turns out, more pharmacies in the UK are resulting in a perceived improvement in patient care, rather than the downturn of establishments as feared from increased competition.

A couple of years ago there was an article that I came across (and found again online here)  that said patients/customers choose pharmacies based first on location and then on their experience with waiting times. From a pharmacist’s perspective, let me just ask WTF?? and go on to rant a little bit, firstly prefacing said rant with an admittance of being as equally annoyed as anyone else at having to wait for anything.

To me, what this is saying though is that patients are basing their inverse value on a pharmacy by how many others go there, not by the service the receive there. I say this because what these surveys fail to make clear is that waiting for a prescription is the result of OTHER people waiting for a prescription, NOT because the pharmacist is just sitting around Googling the latest spring fashions or because they are in someway purposely causing this wait. On the CONTRARY! The basic philosophy behind any pharmacy counter is to get these people OUTTA here ASAP, especially the ones with screaming crying small humans (and maybe with the exception of the hot hunky lifeguard who has come in to get some after sun lotion and needs help getting at the “hard to reach” spots on his back…because THAT happens all the time…)

I think  a wise addition to these surveys is to ask people WHY they think they’re waiting for “so long” at a pharmacy.  Sadly, I think the answer would rank up there with why people have to wait for someone to bring them fries at McDonalds rather than an understanding of professional services.

Hmm well, this took 15 minutes…another quarter of an hour down.

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May the (work)force be with you

by Elixir on May 25th, 2010 - Anecdotes, From the frontline


I’m feeling a little  over-worked lately and as such haven’t been POQing as much, in more ways than one (did I type that out loud? Filter…filter…).   I find it funny how feeling over-worked can take on so many variations of tired-ness.  At the moment I seem to wake up looking at my Outlook, check my mail to and from the office and am still staring at one project or another by the time 10pm rolls around. This is not only leaving me tired but tired of  all things work-ish, including several colleagues I’d like to squish down on the copy machine just for kicks.

Anyyyhoooo…I’ve just spent the last paragraph complaining and yet when I look back at what it meant to be BUSY and  TIRED in my community pharmacy days, I would not trade what I have now for anything. Back lo’ those many years I spent a whole year working relief in some of City X’s most busy pharmacies, ranging from the most-posh to the most-not neighbourhoods. The Pharmacy Chain that I worked for had a system of “urgent”, “soon” and “later” prescriptions and there were some 8 and 12 hour shifts that I could not get my head far enough above the “urgents” to even make a dash to the powder room. In TWELVE HOURS. Of course I hadn’t  ingested any liquids during that time either so it didn’t really matter.  In one heroic instance there was a sea of patients waiting for their “urgents” and one Grumpy Mc Grumpy pants was getting a little testy – after all, he HAD been waiting for 5 minutes, tsk tsk on me the lone pharmacist and my 2 tech rangers.  Then, a lovely women who can best yet still inadequately be described as “angelic”  snapped back – THEY ARE GOING AS FAST AS THEY CAN. I wanted to hug her. And did her script first – BOO YAH!

But in various circles that I lean in to every now and again there is a lot of attention on the pharmacy workforce situation, both in the homeland and abroad. Years ago there truly seemed to be a pharmacist shortage – we named our price and got it, DAMMIT! Our price, our place, our benefits, you name it. Now, however, the tables seem to be turning – jobs seem not to be so plentiful and the utopia has all but disappeared.

This of course is a far cry from what has come to be known as the global health workforce crisis, a situation that claims to need thousands of skilled health workforce in any manner of country. The World Health Organization has even developed a Global Health Workforce Alliance to deal with such issues.  While I do not deny that skilled and trained healthcare professionals are pinnacle to the health of communities, regardless of socio-economic development, I can’t help but wonder how increasing pharmacists in countries that have no water and food will make the most efficient difference to people in need.

I’m just sayin’, is all.

In the meantime I would rather work 24 hours on a paper than ever, EVER fight with the mo’fo’ insurance-problem-label-making-3rd-party-reimbursement computer system again.

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OTC yeah you know me

by Elixir on May 9th, 2010 - Medicines, Patient Care

prilosec_feature3In an attempt to cease and desist several (hopefully) temporary ailments, have to do some battles with some OTC meds this weekend. In my current place of residence the choice is slim and not entirely inspiring…nor effective.  Not to mention that their availability is placed almost solely in “parapharmacies” that resemble anything but a pharmacy, especially in their choice of meds.

On the contrary, I remember taking a spin through a pharmacy in a recent visit to the States. If any country has perfected the art of the Over The Counter Medicine, it is the United States. I was actually quite shocked to see Prilosec OTC front and centre (I was, perhaps naively, even more shocked to see that their website offered a free sample…thank you, Proctor and Gamble).

Don’t get me wrong, it’s not that I don’t fully appreciate the ease of availability of this and these types of medicines – I am pining for such this weekend, actually. But something like Prilosec (omeprazole for the generically tied) screams for pharmacists intervention for reasons which will all know yet I feel compelled to relist here – chronic treatment of symptoms for a potentially harmful underlying cause could lead to even more damage and serious conditions.

What scared me even more however was that I was browsing through the US FDA website for their guidelines on Regulation of Nonprescription Products to find these points explicitly listed:

OTC drugs generally have these characteristics:

  • their benefits outweigh their risks
  • the potential for misuse and abuse is low
  • consumer can use them for self-diagnosed conditions
  • they can be adequately labeled
  • health practitioners are not needed for the safe and effective use of the products

Now from what I hear about the FDA combined of what I hear about the American populace’s tendency to lawsuits I am almost certain that a very large team of very smart experts came up with these guidelines. But I’m not sure I agree, to be honest. Sure, anyone can read the box…but do we really want to encourage more self-diagnosis? And, are we really comfortable by saying a medicine like omeprazole can truly be used safely and effectively without interaction with a healthcare professional (namely, pharmacists).

I’m not. I admit I would be more likely to agree if more were a “behind the counter” (BTC?) medicine that needed to be requested. The slight increase in bother would go great lengths in prevention and in connecting patients to pharmacists – a step that seems to becoming increasingly eliminated.

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by Elixir on May 5th, 2010 - Anecdotes, From the frontline, Patient Care

At the outset of writing this I can’t help but think of a recent Beyoncé/Gaga offering  – who doesn’t love that scene in Lady-Gaga-and-Beyonce-Telephone-gone-too-farTelephone when they escape in the PussyWagon? No one, that’s who. Also a rather hard core alternative to the solo-Beyoncé effort of Videophone which to be honest is rather Lara Croft, if you ask me. But I digress.

I’ve been reading quite a lot lately on telemedicine, the art, if you will, of providing medical advice and services over the telephone/internet. In essence, this allows those who normally have limited or no access to health professionals/care the resource of communicating with medical professionals via telephone and internet.

A recent article in Pharmacy Choice teases at the notion of an expanding industry in the US, saying that  [the company] American Educational Telecommunications allows rural patients and health care providers to work with medical professionals at regional or urban medical centers. AET’s technologies also facilitate distance learning to train medical professionals in other parts of the world; the company’s technologies help ensure that rural populations have access to the same quality of medical care as those admitted to hospitals.

Even more…I think the word I’m looking for is…intriguing…is that I have now heard that some US hospitals are hiring pharmacists who work off-site, some working as far away as Europe and Asia. They receive the electronic patient records and doctors’ orders and authorise prescriptions which are delivered on-site. From what I hear, the pharmacists are extensively contacted for advice  and communication ensues as it would if the pharmacist were there, save for of course the pharmacist to patient interaction.

I think I have convinced myself that this is a BRILLIANT idea, one that sparks enthusiasm for underserviced areas the world over.  The pharmacists have the continued opportunity to practice the art of medicines management, what they do best while at the same time the convenience of staying chez lui. Win-win.

The biggest argument I see arising is, as mentioned, the lack of pharmacist-patient interaction. But, let me be the devil’s advocate, just for a teeny moment. Does it really matter? As much as we have fought to be recognised as a healthcare provider and not just a medicines dispenser, doesn’t our TRUE value still lie in what we can provide with regards to medicines information and how that may best be of use to patient recovery?

Of course it’s better to have a pharmacist onsite, but if the choice is between telemedicine providing the information for someone else to use and no pharmacy-services at all, dial me up.

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Rumble in the Northern Jungle

by Elixir on May 2nd, 2010 - Events, From the frontline, Industry News


It’s good to be back POQing again after a small hiatus – nothing like a good POQ to get back into the swing of things.

The biggest news on the international pharmacy front seems to be the highly covered and sizzling situation boiling over in the province of Ontario in that giant country all tucked away up in the northerly direction of the States. That’s right, new legislation in the normally subdued and mild-mannered Canada has got both sides SEETHING with contempt on who will be to blame for what is expected to be the demise of independent pharmacy and to the fate of the pharmacy institution as a whole.

As was covered in one of the country’s most far reaching papers, The National Post, as well as numerous other hard copy and online news magazines (see here Macleans), the Ontario government as set in motion legislation that will put a cap on the allowable amount charged for generic medicines, that is pharmacies can now charge at maximum 25% of the brand name costs. The decision comes after literally years of budget review on how to decrease the annual millions spent by the government on drug costs – Ontario is the second largest medicines payer in North America and pays for medicines for seniors, the poor and many other social sectors. It should be noted, however,  that this legislation also limits the selling price to private payers, that is insurance companies or patients themselves.

The result, as it seems, is that Ontario pharmacies will suffer huge losses in revue, revenue that is used to staff pharmacists in the extensive hours that are now the norm and for services such as patient counselling, pill packs, and general pharmacy services that have come to be the norm, as it appears that pharmacies in this province gain significant revenues from increases in generic medicines sell-price as well as supplementation from the generic companies themselves for stocking certain products (read the full explanation in the Macleans article here).

OK, we all know there is a global economic crises but as a once-practicing pharmacist I am appalled by what I read in the Maclean’s article, MAINLY that these budget-cutting decisions were made by a politician who is NOT a pharmacist. What I find equally appalling is the unbreakable bond that societies and governments continue to make between the product of medicines and the practice of pharmacy – nowhere in this new legislation, it seems, were payment of patient services considered, public health influence or communicative aspects of the profession. It was merely the drugs, and that’s it. Are we still just the pill-pushers?  *shudder*

But, those recently mentioned services are what will be chopped from the pharmacy block when revenues dip, pharmacies cannot staff a sufficient amount of pharmacists nor stay open long hours. What the government failed to consider is that a large portion of those revenues went to subsidise these patient-centred services – are pharmacists expected to do it for free?

In my mind, this appears to be a huge step back for the profession in a country that is known for respectable and universal healthcare. I can’t pretend to know all the details but if I were a practitioner in an Ontario pharmacy, I’d be up in arms.

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These genes aren’t for sale

by Elixir on April 8th, 2010 - Events, From the frontline, Industry News

genome4A very interesting twist in legislation just happened in the US, one that will definitely set a precedent in the foreseen lengthy race between science and technology and the law.

Once again we have our friends at Wired to thank for bring us the story. As they so eloquently put it:  “When you went to sleep last Sunday night, 20 percent of your genome belonged to a researcher or company. One day later, following federal district court judge Robert Sweet’s ruling, it belonged to you”.

What has happened is that Federal Government in the US has put a ban on gene patents. That is, those companies that have invested billions of dollars sequencing certain sections of the human genome for drug/treatment development can no longer claim them under patent (and, therefore, hold a monopoly on studying that portion of the genome).

Although I honestly sympathise for the drug companies, in this particular case one called Myriad (even the National Public Radio was following the story…good times…) I more strongly lead towards Wired (and the general, common-sense equipped public) in that it is absurd to allow gene patents – no one created them, we have just discovered them. It’s like patenting a bad ex boyfriend – we feel like we are owed something for the years we spent trying to figure them out, yet can claim no proprietal rights. (Thankfully?).

So, now what? Some feal that this could cause competition within the biotech industry, resulting in a boon for patients. I myself think this is secondary and agree with another sector in that the focus must now be on using these gene discoveries to build new an innovative treatments,  further advance medical therapies and give patients real hope. Basically, as  Linda Avey, CEO of personalized genomics company 23andMe, says in her blog: “My hope is that this ruling stands and companies will need to actually innovate and create new advances based on genetic findings, not dependent on sole access to them”.

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Pharmacists make mistakes too

by Elixir on April 6th, 2010 - Uncategorized

It’s been a busy, hectic time lately (as is evident from lack of posts) and today was not a people-pleasing day at work. 600px-Red_x.svgFrom Moment 1 (well, actually since last week, it would seem) The Bossman was NOT happy on a certain unnamed issue, but none that was directly my fault save for the fact I have the inability to read minds (still haven’t achieved pure Wonder Woman status).  I’m usually the first to admit when I make a mistake but this time, I was not backing down. BRING IT ON!

But the whole situation brought a little more attention than normal to an article posted  on Medical News Today about how the Royal Pharmaceutical Society of Great Britain is pushing the UK Department of Health to decriminalise dispensing errors by pharmacists/in pharmacies. This would mean that pharmacists, the ultimate responsibility holder in the dispensing of medicine, would not be held criminally responsible for medication errors in the pharmacy.

I fully support this legislation (or, de-legislation as it is) and agree with the RPSGB when they say that “the decriminalisation issue is of key importance to both pharmacists and patients. The new guidelines will encourage the reporting of errors, from which pharmacists and colleagues can learn how patient safety can be further improved“. The only upside to a mistake is the opportunity to learn from it, especially regarding the evaluation of systems and protocols used in a dispensing procedure.

However, pharmacists are put in a unique situation, similar of course to other health professionals: their mistakes can cost lives. And when lives are lost, people want someone to blame.

When I  first graduated there was a devastating story about a medication dispensing error in a pharmacy where a friend of mine worked – the error resulted in the death of a child and the pharmacist “responsible” lost his license and was at risk of going to jail (however country in question did was not inclined to sue beyond reason, and a lost license served the purpose).

Of course, there is no way to compensate for this loss, but, in all out fact, it was a mistake. There is a very BIG line between a mistake and intent to harm and although accountability is a pinnacle trait of our profession, reason and the understanding that we, too, are human, must be taken into account.

I’m curious to see how long it takes the UK  to see this through.

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Too many pharmacists, or too few roles?

by Elixir on March 28th, 2010 - From the frontline, Industry News

kangaroosI have just come across an article that is bold enough to admit that in a few years, there will likely be an oversupply of pharmacists (in this case in Australia, with a work force model predicting that there could be a surplus of 2,009 pharmacists in Australia within five years, rising to 2,594 by 2020 and 3,582 by 2025). Besides the fact that I think this trend will apply to far more countries than just Australia (more on that later) I find this a refreshing take on the argument that the health workforce supply is in dire straights all over the globe, mostly in rural and developing areas. Just because people don’t have access to the workforce, doesn’t mean it’s not there (I can see the hate mail already…).

Call me skeptical, but I find a global pharmacist shortage a hard pill to swallow (come on, this pun was in the mail from the very start of this blog!) …in fact the oversupply is a situation that any amount of common sense could have predicted for almost 10 years now, stemming from an under-supply generated by niche (and, as they were, transient) markets  followed  by an urgent push to graduate an increasing number of pharmacy professionals, in any case  in Canada and the US. At the time I graduated, bonuses were the norm, pharmacists could name their wage and hours and it was an employee market, to say the least, as pharmacies needed more pharmacists than there were. Now, from what I hear, bonuses are few and far between save for the very rural areas and graduates have a much more limited deck of cards to choose from.

However, this predicted predicament has prompted the Pharmacy Guild of Australia to take an interesting view, saying that this is the perfect opportunity for pharmacists to expand their roles beyond that of traditional pharmacy services. It’s a brilliant plan, which both defends the number of graduating pharmacists (rather than scaling them back) and opens the door for increased scope of practice.

There are inherent challenges of course, the most prominent being payment for such services. This calls on a shift of philosophy of reimbursement by healthcare payers – government, insurers, what-have-you. The second and perhaps more important is the shift in the general philosophy of the practice of pharmacy – future pharmacists would have to be aware that if they want to have a job after graduation, they may need to perform competently within circles that have normally been reserved for other allies on the healthcare team.

That being said, I like this approach. It raises the stakes for all and forces pharmacists to keep up with the times – stake their claim before it’s taken away!

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by Elixir on March 25th, 2010 - Events, From the frontline

americanflaghealthcarereformpinthumbI’m returning back to the last topic posted  as the results of the US health care reform bill (and their consequences) come trickling down to the rest of the world like tasty little rivets of nectar to bees. Once again our friends at APhA have given us great coverage of the results and what that could mean for pharmacists – and patients.

From what I can gather,  although there are still lingering debates over broader legislation issues, the bottom line is that more people in the States will be getting healthcare (YAY!)  and with many pharmacy-specific services outlined in the package, pharmacists could get a boost up that ladder of recognition for the services we provide (DOUBLE YAY!).

On the top of the list of phun pharma-goodness is an APhA supported grants programme for medications therapy management (MTM), which will place pharmacists in their rightful position as top dog when it comes to managing patients and their medicines. BOO YA! What the government is saying by supporting this programme is that they believe 1. pharmacists know medicines better than any other health professional 2.  as such they should be the link between medicines and patients and 3. they should be PAID for these services.  I like.

Other stipulations in the bill are indeed extremely positive, yet I think they ground out the  harsh truth of what health care is (was?)  in the States. The fact that  it took federal law to  forbid insurance companies to deny  insurance to children due to a pre-existing condition is appalling. But, I digress.

At any rate, many seem optimistic that this is a first step to  ground breaking healthcare reform  in “the most powerful country in the world” (which formerly seemingly punished sick children).  Let’s hope, for their sake.

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It’s just a bill, sitting there on Capitol Hill

by Elixir on March 21st, 2010 - From the frontline, Patient Care

Our friends in the USA are facing some tough decisions this weekend regarding healthcare and how/if the millions of schoolhouse rock bill2uninsured in the country will finally be offered an olive branch of hope from the Federal Government’s new healthcare bill. Although,  a sharp bite of reality is that healthcare reform of such a remedy will not come without a spike in taxes, for all…a consequence usually met with less enthusiasm by the American public than the lack of healthcare itself.

I’d like to commend the American Pharmacists Association (APhA) for their amazing coverage of the proceedings AND for their wholehearted committment to getting pharmacists in the ring as key players in improving healthcare via their knowledge of medicines and ability to connect to patients outside of the doctor-patient route. Their Message to Congress includes five key strategies that aim to prove that costs can be lowered AND patients can have better access to medicines and medicines information when pharmacists are more extensively utilised, accessed and supported (including graduating more pharmacists to fill poorly serviced rural communities).

What I like most about APhA’s campaign is their goal to involve their Members – individual pharmacists – in the fight for healthcare reform and improved care via the efficient and effective use of our profession. Not only were Members invited to film videos about what they would tell President Obama about the pharmacists role in healthcare reform (watch videos here), those who attended the recent APhA National Meeting in Washington DC were invited to go on tours to Capital Hill  to REALLY get their voice heard! Although many things about the States frighten me like a scared turtle into a shell (flagrant gun use and monster  “feed a family of four on one burrito” -sized meal portions highly ranking), I HIGHLY commend this sense of empowerment from APhA to it’s Members – GO PHARMACISTS!

I’m also very curious to see the result of a healthcare bill (let us all thank School House Rocks for making the journey from bill to law a  rockin’ good time),  but I’m more curious to know – what would YOU tell Obama?

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