OCTOBER ,Edition # 35 , 2001

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I am always pleased to find that mine is not the only voice calling in the wilderness.
Shortly after sending off my last Computachem offering I finally managed to read the August issue of the Australian Journal of Pharmacy and, guess what I read? Chas Collison, from the APESMA (Association of Professional Engineers, Scientists and Managers, Australia), wrote an article on workloads and professional burnout that was almost identical to mine!
Who says that "great minds" don't think alike?
Chas raises the point that pharmacy has created much of its own problem by creating an environment that is not conducive to safe, professional service.
He highlights the, all too common, scenario of the patient who has probably waited some days to see the doctor suddenly expecting instant dispensing of the prescription.
He comments on how the different perception the consumer has of the doctor (a health professional) and the pharmacist (health professional or merely a retailer?) gives rise to different expectations.
Pharmacy, by falling for the instant service culture, is selling itself short.
We are health professionals, not fast food merchants.
That aside, I recently attended a Quality Use of Medicines (QUM) committee meeting at a local division of general practice where medication reviews and standards of practice were topics of discussion. I listened with interest as doctors and aged care facility operators talked of their experiences with pharmacists carrying out medication reviews in nursing homes.
It quickly became apparent that there is a wide disparity in the quality of services being offered by consultant pharmacists.
Concern was raised about the all too apparent "corporatisation" of the medication review industry.
Here in WA it seems that two or three pharmacists have cornered over 50% of nursing home patients for reviews and, from all accounts, a similar picture is seen in South Australia. The group expressed its fear that the reviews were merely exercises in revenue gathering rather than a professional interaction between two health professionals to ensure quality use of medicines.
As a pharmacist this perception worries me. I would like to think that, in most cases, the patient's care is of paramount importance.
A second concern of the group was the potential conflict of interest if the reviewing consultant pharmacist was also involved in the supply function.
Those of the group from nursing homes commented that reviews from independent consultants appeared to be more professional and that there was a more positive response from doctors to these pharmacists.
The imminent introduction of DMMR (Domiciliary Medication Management Reviews) will place greater emphasis on the professional role of the pharmacist, an issue recognised by AACP (Australian Association of Consultant Pharmacists) which has responded by producing a special module to prepare accredited pharmacists for the new process.
Communication will become of paramount importance, not only with the patient but also with the prescriber.
Given the somewhat negative responses I hear from doctors, DMMR will not succeed unless pharmacy can demonstrate its professionalism to the medical fraternity.
Will we, as a profession, be able to move to the new model where our knowledge generates the income rather than relying on the script?
Intellectual property will, I hope, become the pharmacy revenue of the future. DMMR has, unlike the Dept of Veteran Affairs (DVA) community based MMR process, given pharmacy a chance by precluding doctors from carrying out their own medication reviews.
At least the new service has some chance of getting off the ground, as prescribers will be paid for the inter-profession case conference and so are more likely to be willing to refer.
Leone Coper, of AACP, has highlighted many of these issues in an article titled Communication, concordance and DMMR appearing in the September issue of the AJP. I recommend all pharmacists desirous of taking part in DMMR read this as it gives a good overview.
Pharmacy most continue to emphasise, and prove, that it is not only willing to be an integral part of the health care team, but also has the expertise and capability to improve patient outcomes.
Doctors must be shown that pharmacy is not attempting to replace them but that, working with the patient, the two professions can complement each other to get the best results.
Do I dream or is this the only way that our profession can move into the future with any hope of survival?

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