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Debbie Rigby

The future of professional


practice: why standing still
is not an option
Topics

Evolution
Evolutionof
ofpharmacy
pharmacypractice
practice

Drivers
Driversfor
for practice
practicechange
change

Change
Changemanagement
managementstrategies
strategies

Benefits
Benefitsof
ofprofessional
professionalservices
services

Future
Futureroles
rolesfor
forpharmacy
pharmacy
Pharmacy is living on the edge!
Paradigm shift

Service providers with a retail element,


rather than retailers with a service
element

Differentiate - innovate
compounding
chronic
disease self-
management

Evolution of dispensing
disease
state
pharmacy practice
management

pharmaceutical
care

comprehensive
medication
reviews
Evolution of pharmacy practice
 Shift to pharmacists being directly responsible
for outcomes, quality of care, quality of life and
directly responsible to the patient

 Change from product-orientated focus to patient-


orientated focus

 risk-takers or innovators
Pharmaceutical care

 pharmaceutical care is a patient-centered,


outcomes oriented, pharmacy practice.

 pharmaceutical care is the responsible


provision of drug therapy for the purpose
of achieving definite outcomes that
improve a patients quality of life

Hepler CD, Strand LM. Opportunities and responsibilities in


pharmaceutical care. Am J Hosp Pharm. 1990;47:533-543.
UK experience
 MURs (medicines use review)
 establish patients actual use,
understanding & experience
 identifying, discussing and resolving
poor or ineffective use of drugs
 identifying side effects and drug
interactions that may affect
compliance
 improving clinical & cost effectiveness
of drugs reduce wastage

 Max. 250 per pharmacy pa @ 25


Canadian experience
 Meds Check, a medication review program, as
the first professional service available under the
Ontario Drug Benefit Program that began April 1,
2007

 one-time payment of $1,000 to pharmacies once they


have initiated the service to support pharmacists in
implementation

 $50 per service for annual review in patients taking 3


or more chronic prescription medicines

 aim: to maximise patient adherence to drug therapy


Australian experience - 2002

n=1131

IJPP 2007;15:185-191
Professional services

prior
prior to
to 1997
1997 1997
1997 -- 2007
2007 --

Prescription Clinical
Adherence
review & medication
services
dispensing reviews
Topics

Evolution
Evolutionof
ofpharmacy
pharmacypractice
practice

Drivers
Driversfor
for practice
practicechange
change

Change
Changemanagement
managementstrategies
strategies

Benefits
Benefitsof
ofprofessional
professionalservices
services

Future
Futureroles
rolesfor
forpharmacy
pharmacy
Our long-term function doesnt lie in that area
(supply function and price). It lies in cognitive
services

John Bronger
President, Pharmacy Guild

Grist J. Pharmacy gets a B for effort. Pharmacy News 2002;4 April:2


From pyramid to coffin

Changing age structure of the Australian population, 1925-2045

Age
80 1925 2000 2045

70
60 females
males females males males females
50

40

30
20

10

0
1.2 0.6 % 0.0 0.6 1.2 1.2 0.6 % 0.0 0.6 1.2
1.21.2
1.2 0.6 % 0.0 0.6 1.2

Productivity Commission 2005, Economic Implications of an Ageing Australia,


Research Report, Canberra.
Ageing is us

 By 2044-45 one in four Australians will be


old (65 years or more) double the
present share.

 At that time, the old will comprise around 7


million Australians, up from the present 2.5
million.

Productivity Commission 2005, Economic Implications of an Ageing Australia,


Research Report, Canberra.
Chronic disease burden
 60-70% of patients in pharmacy have
chronic disease

 Obesity more consistently associated with


chronic illnesses such as diabetes, heart
disease and asthma than smoking or
alcohol use

Community pharmacists must position themselves


to meet the needs for chronic disease management
Chronic disease

 diabetes prevalence doubled over last 20 yrs


 asthma 14% children 10% adults
 arthritis 3 in 10
 cardiovascular disease 1 in 5
 cancer 2nd leading cause of death
 mental health 13% of disease burden

OPPORTUNITY
Intergenerational Report

 in 40 years the Government will spend an


average $2200 per head on medicines
each year, six times today's bill
Change drivers

 consumer expectations

 technology

 ageing population

 increasing burden of chronic disease


Change management
We can anticipate change, initiate it, and
implement it, or we can let it happen to us,
and respond to it. Either way, the change
keeps moving.

Adapting to change is necessary


in order for improvement or
progress to occur.
Topics

Evolution
Evolutionof
ofpharmacy
pharmacypractice
practice

Drivers
Driversfor
for practice
practicechange
change

Change
Changemanagement
managementstrategies
strategies

Benefits
Benefitsof
ofprofessional
professionalservices
services

Future
Futureroles
rolesfor
forpharmacy
pharmacy
Impact analysis
 What is your current situation?

 What is the impact of your current


situation?

 What is the ideal situation?

 What would be the impact of the ideal


situation?
What makes us indispensable?

 Supply 
 Front shop 
 DAA packing 
 Drug information 

 HMR, RMMR 
 Individualized drug information 
 Drug expertise (QUM) 
 Health Professional accessibility 
Change management

 Cannot continue to rely on Am I


ready for
dispensing change?

 Shift towards services


 Point of differentiation

 To meet the challenge of


change, need the tools to
implement the change
Change management

..there has never been a better


time for pharmacies to rethink
their approach to business. By
providing services and linking
these to product sales,
pharmacists can not only
ensure a profitable livelihood, but
also contribute to better overall
health for the community

Source: PricewaterhouseCoopers
Topics

Evolution
Evolutionof
ofpharmacy
pharmacypractice
practice

Drivers
Driversfor
for practice
practicechange
change

Change
Changemanagement
managementstrategies
strategies

Benefits
Benefitsof
ofprofessional
professionalservices
services

Future
Futureroles
rolesfor
forpharmacy
pharmacy
Management of change

 Benefits cannot be achieved without


change

 Change cannot be sustained without


benefits
Community pharmacy benefits

 trust
 accessibility
 medicine experts
 reduced health costs
 better health outcomes for consumers
through better use of medicines
Different & important

(McKinsey Quarterly - May 2004)


Change management

Dexter Dunphy et al. The Shape of Our Future. Change


Management and Community Pharmacy Project. 2005
Price promotion
What message does it send to consumers?
Diabetes patient
Monitoring
Administration
Diabetes Rx equipment
Aids eg DAAs

Antihypertensive Wound
Rx management

Other Rx
Lipid Rx Foot care
eg aspirin, NRT,
weight loss
DMAS
Leverage per patient per annum

Sales (Rx, OTC, etc)


$5,000

Gross profit dollars (32%)


$1,600

DMAS gross income per patient


$458

Total income dollars


$2,058

Gross income for 14 patients p.a. = $28,812


Value of a loyal customer

Consumer loyalty

DMAS DAAs & OTHER


HMRs
& asthma Med Profiles SERVICES
Topics

Evolution
Evolutionof
ofpharmacy
pharmacypractice
practice

Drivers
Driversfor
for practice
practicechange
change

Change
Changemanagement
managementstrategies
strategies

Benefits
Benefitsof
ofprofessional
professionalservices
services

Future
Futureroles
rolesfor
forpharmacy
pharmacy
Professional services

2CPA 3CPA 4CPA Future

QUM services Pharmacist


RMMRs HMRs prescribing
DAAs CDSM
QCPP Medication Specialist services
profiles Health promotion
CMI & prevention
DSM
e-Health
Hep C Pharmacovigilance
4th CPA Professional Pharmacy Programs &
Services

Medication Management Review Better Community Health


 Home Medicines Reviews  QCPP, R&D & eHealth
 Residential Medication Reviews  Asthma & Diabetes
 Accreditation incentives  DAAs
 MMR Facilitators  Medication profiling
 Practice change program
 Communicable diseases, EHC counselling

Indigenous programs Rural Programs


 ATSI pharmacist scholarships  Rural Maintenance Allowance
 ATSI pharmacy assistant scholarships  Start up / succession allowances
 S100 allowance  Pre-registration incentives
 Improved access programs  Rural workforce program
Professional Pharmacy Service Continuum

Increasing pharmacist Assisting


time / cost due to patients and
complexity of service / GPs in
Quality Use HMRs & Disease
patient of Medicines Residential State
Medication Services Monitoring
Medication
Assistance to remote and
Reviews
Medication Services Aboriginal Management
Clinical Dose Profiling (Diabetes Medical
Interventions Admin Services and Asthma) Services
Consumer for identifying Prescribing Aids (DAAs)
Medicines Drug S2 / S3
Medication Information Related
Dispensing (CMI) Problems

$500 service
10 incentive for
~$10 ~ $25-$30 $320 - $400 $6 - $10k p.a $180 & $130
per CMI
? 5 CPA
EHC per week per service per service + $3k travel
per service
? 5 CPA
+$12.50- $7.50
+co-payment +$5 co-payment
Counselling? co-payment

$1,080 (HMR)
$4,000 $500 p.a?? ~$7,000 ~$3,000 $8,730
$3,300 (RMMR)
Professional services
 smoking cessation  adherence monitoring
 weight loss  assistive technology
 INR testing  chlamydia testing
 BMD testing  immunisation
 cholesterol tests  continence care
 BP monitoring  chronic disease self-
 wound care management
 compounding  disease state Mx
 pharmacovigilance  pandemic planning
 prescribing  pharmacogenomics
INR monitoring
Genetic polymorphism

AmpliChip Cytochrome
P450 Genotyping
Test

 analyses CYP2D6 and


CYP2C19 genotypes
Chronic disease

 diabetes prevalence doubled over last 20


years
 asthma 14% children 10% adults
 arthritis 3 in 10
 cardiovascular disease 1 in 5
 cancer 2nd leading cause of death
 mental health 13% of disease burden

= OPPORTUNITY
Preventable risk factors

 Lifestyle changes
 smoking
 alcohol use
 physical inactivity 1/3 of chronic disease
burden attributed to
 poor diet & nutrition these risks

 excess weight
 high blood pressure
 high blood cholesterol
Health care providers role

 reducing risk
 early identification of disease
 managing acute conditions
 long-term care
 care in advanced stages of disease

Where does community pharmacy fit in?


Chronic disease self-management

 self-management enhance patient


responsibility for own health & with support
of pharmacists, make informed decisions
and better management to improve well-
being and quality of life

 optimising self-management is essential


for achieving patient-centred care
Consultation room

 Community pharmacy is
changing. With pharmacists
clinical advisory role coming to
the fore, pharmacy premises in
the community are having to
change, too. This is
demonstrated by the
proliferation of consultation
areas in pharmacies throughout
the UK.

Pharm J 2007;279:225
Professional counselling room
What does
the future hold?
Time for pharmacy to move on
 move on from their 'old' ways of selling unprofitable but traditional
pharmacy lines such as gifts and toiletries.

 pharmacies should be implementing the range of cognitive services


now available in some cases (eg HMRs and RMMRs) and soon to
be available in others (eg asthma and diabetes disease state
management programs, medication profiling and dose
administration aids assistance).

 persuasive business case, clearly justifying the introduction by


pharmacies of these services - income generated from these
services was, in fact, only the tip of the iceberg as there are a whole
range of complementary goods and services that pharmacies might
provide to their patients.

"If pharmacies don't quickly convert to health solution providers,


they can blame no-one but themselves for their failure."

Bruce Annabel PAC 2007


Time for pharmacy to move on
 If pharmacies embrace solution marketing and actually bite the
bullet and forego many of the non lucrative and costly categories
such as gifts and toiletries, there will come a time when the
pharmacy of tomorrow need not have to occupy as large a footprint
as they do today. A substantial reduction in floor size could mean a
substantial reduction in rental outgoings and could be the difference
between a fair ROI and a good ROI. Coupled to this their stock
investment would reduce with all the logical flow on benefits. I see a
new practice and financial model for pharmacy emerging. It will be
interesting to see who treads this path first.

AusPharmList 29 August 2007


Time for pharmacy to move on
 Imagine having 2 pharmacists and doing 350 scripts a
day as well as trying to provide these services as well..
It's a nice idea and something we should be working
towards, but I don't see a place for it in todays pharmacy
except for exceptional circumstances. There needs to be
suitable training programs in place and foreseeable
income for it to become more common.

AusPharmList 30 August 2007


Put the pharmacist
into pharmacy

Knowledgeable, personal, EBM, QUM,


approachable, accessible

and makes money!


Skills, knowledge & attitude
 Excellent communication skills
 Innovative attitude
 Willingness to overcome barriers
 Confidence in knowledge base and role of
pharmacist in medication management
 Good listener and learner
 Specialised knowledge eg geriatrics,
asthma, diabetes
Professional services

Todays opportunity, tomorrows


imperative!