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The following discourses with Kevin McAnuff (1945-2004) over the
last seven years of his life focused on two likely strategies
for pharmacy to implement nationally in the near future.
McAnuff believed
in a wide health role for community pharmacy.
He enrolled in my Clinical Investigations 527 classes of 1997
which trained graduate pharmacists in clinical testing on six
Sunday afternoons .
He sacrificed his scarce time because he realised that screening
with clinical tests was a key for unlocking undetected diabetes,
high blood pressure, hypercholesterolaemia and other risk factors
in more than a million untreated Australians .
(1)
This could create a river of pharmacy clients referred to GPs,
a permanent new flow of prescriptions for pharmacies and primary
prevention for the population on a scale limited only by myopic
colleagues.
The menu of commercial, professional, political and population
health benefits was an unrivalled opportunity for pharmacy.
He felt that monitoring with clinical testing, would strengthen
pharmacy's control of S3 medicines and enhance fees for the prescribed
therapies, which require test results to assess their effectiveness.
(1)
Events have gone wrong for pharmacy since the March 2003 release
of the Review of Commonwealth legislation for pathology arrangements
under Medicare . (1)
Point-of-care testing (PoCT) was recommended where its "
clinical effectiveness and cost-effectiveness could be demonstrated"
following submissions by our Curtin group and the Pharmacy Guild
that pharmacy was well placed to provide it.
PoCT in pharmacy refers to on-site clinical testing (BMI, Blood
pressure, glucose) for the purposes of screening or monitoring
.(1)
The Sydney
Faculty of Pharmacy has taught clinical testing to undergraduates
for years.
The Guild and Curtin University submitted that the high public
access to pharmacies was a logical location for the million or
more people with undetected serious test abnormalities .
They also referred to GPs poor performance in past evaluations
of PoCT in Australia or elsewhere.
But these were disregarded and a PoCT Steering Group without pharmacists
was appointed.
PoCT became
defined as "pathology testing performed by or on behalf of
a medical practitioner at the time of consultation , allowing
the results to be used to make immediate, informed decisions about
patient carte". (2)
The Steering Group reported the trial design and standards for
PoCT in general practice and have let tenders for a Trial Manager,
providing QAP (quality in pathology) for the trial, plus a supplier
of devices and a trial evaluator by June 2004 and implement the
PoCT trial in GPs .
In hospitals in Australia and overseas, pharmacists demonstrated
in the 1970s they improved the application of laboratory results
to improve drug safety and effectiveness in patients. (3)
But community
pharmacists couldn't emulate their hospital colleagues' efforts
because they was no third party payment, they were inadequately
trained, the regulations for pathology testing excluded them and
testing devices were too expensive or cumbersome. (4)
We now must await the results of the GP trials in PoCT .
· McAnuff
was quick to realise that media reports on the diversion and misuse
of therapeutic drugs like pseudoephedrine and dexamphetamine endangered
pharmacy's medication custodianship hence required prompt decisive
responses .
WA pioneered storing pseudoephedrine products behind the counter,
recording the details of sales and produced the striking pseudoephedrine
displays in early 2003, which were exported to other States .
(5)
He , the Guild WA's Harry Zafer and the HIC in WA alerted pharmacists
as early as May 2001 to exercise diligence with issuing repeats
for dexamphetamine, a full 18 months before Western Australia's
world highest consumption was first published . (6,7)
Again with Harry Zafer and Professor Michael Garlepp the head
of Curtin University's School of Pharmacy, he led the three pharmacy
bodies in 2003 to jointly propose to WA's Inquiry into ADHD the
best way of cutting misuse of licit psychostimulants, was for
government legislation requiring patients prescribed an S8, to
allow online access by their doctors and pharmacies to their state-
and HIC-held S8 medication histories and limiting patients to
one doctor and pharmacy for the S8. (8)
These examples
of McAnuff's ideology or aspirations are now obvious candidates
for community pharmacy strategies in the early 21st century.
References
1. Berbatis
C. Point-of-care payments for pharmacists? (letter). Australian
Pharmacist 2003; 22:340.
2. Australian
Government Department of Health and Ageing. Point of Care Testing
(PoCT) trial. Design for a trial and an evaluation framework for
the introduction of point of care testing into general practice
in Australia. Interim standards for point of care testing in general
practice incorporating PoCT trial guidelines . March 2004. http://www.health.gov.au/pathology/poctt/index.htm
accessed 21 March 2004.
3. Editorial
. Drug and laboratory usage in Australian hospitals. Med J Aust
1980; 1: 148-149.
4. Berbatis C. Clinical testing. Essential CPE. Deakin (ACT):
Pharmaceutical Society of Australia, 2000 (36 pages). ISBN 0 908185
49 9.
5. Patterson
M. Diversion of solid dose preparations containing pseudoephedrine
(letter). Rescript (WA) 2003; 34:12.
6. Zafer
H, McAnuff K. HIC concerns on supply of dexamphetamine . Pharmacy
Guild (WA) Bulletin 2001; Issue 873 (18 May):3.
7. Berbatis
C, Sunderland VB, Bulsara M. Licit psychostimulant consumption
in Australia, 1984-2000: international and jurisdictional comparison.
Med J Aust 2002; 177: 539-543.
8. Berbatis
C, Sunderland VB. S8s - amber lights flashing fro pharmacy (letter).
Australian Pharmacist 2003; 22:500.
Con Berbatis
Curtin University of Technology.
Email : berbatis@curtin.edu.au
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