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There
is an answer - but I needed to undergo the following transition
period before it finally evolved.
Once
again I have to refer back to the pharmacists's disease, the "four
wall syndrome".
I was lucky to re-enter pharmacy as a sole rural hospital pharmacist.
I escaped the inherited "four wall syndrome" of hospital
pharmacy.
The managers of the hospitals in which I was involved became very
supportive of the pharmacy department. I was encouraged to present
papers at conferences eg the first National Rural Health Conference
in Toowoomba about 10 years ago.
It
was quite a shock to realise that there were only three pharmacists
in attendance.
Most participants fitted into one of four groups - rural nurses,
rural GPs, university staff eg from the Monash Uni Centre for
Rural Health, or government representatives.
This reinforced my perception that pharmacy was indeed at the
crossroads, and measures were needed to ensure that it was included
in planning future health services in rural areas.
Once again, as at Directors of Hospital Pharmacy conferences I
was aware that decisions were being made in the capital cities
where the bulk of the population was, but these decisions were
not always relevant for rural practice ie practice in the bulk
of the geographical area of Victoria.
It
was about this time that a few like-minded pharmacists in NSW
under the dynamic leadership of Patrick Mahoney began RIPAA -
the Remote and Isolated Pharmacists' Association of Australia.
This has ensured that rural pharmacists do have a voice in national
health strategies.
It largely contributed to the benefits for rural pharmacists of
the Rural Pharmacy Maintenance Allowance, Emergency Locum Service
and Undergraduate Scholarships.
It
seemed appropriate for me to blaze a trail at the grass roots
level - to all those small hospitals and communities without the
services of a clinical pharmacist, whose only contact with a pharmacist
was just the supply of medications. A drop and run service.
So,
my Medication Management Service began.
A rural consulting service.
In hospitals unable to attract locum pharmacists I provided locum/consultancy
support - a review based on actual experience working in the hospital
as a locum.
The advice was practical, and most importantly for me, was sought
after.
In
the even smaller hospitals I undertook medication reviews as an
accredited reviewer, provided assistance for hospital accreditation,
and provided mini-lectures to nursing staff about medication problems
they had encountered. This service was welcomed by the Directors
of Nursing to the extent that they put the pressure on management
for some regular pharmacy service to be put in place.
We
have to remember that we have specific talents and training to
provide support for other health professionals - but we also have
to remember to promote ourselves.
I
believe it is easier to do this in the country than it would be
in the larger regional towns and cities.
In teaching hospitals there are resident doctors, clinical nurses,
specialists etc all wanting to be involved in case management.
The pharmacist is often seen just as the supplier of the medication.
In the country however, the pharmacist is welcomed for their support
as part of the health care team.
Did
I hear someone say, "That's all very well for an aged pharmacist
who doesn't have to make pots of money, or raise a family, or
have job security."
The
answer: You create your own security.
The sole GPs and the nurses in the small towns welcome any support
a pharmacist can provide.
But there is a difference.
Country folk aren't fools, and nurses have been looking after
all medication problems for ever.
While it is easy to justify pharmacist involvement - the monetary
value of that involvement will reflect the value of the service
you provide!
I
could make pots more money in quite a few different locations
with a mix of locum services, consultancy and medication reviews.
Very rewarding practice to prevent the onset of the "four
wall syndrome" (Phone me on 03 5474 2415 for details if you
are interested )
Another
way to prevent the onset of the "four wall syndrome"
is to obtain government grants.
Each year small amounts of funding are available for medication
awareness programmes eg "Be Wise with Medicines".
The funding is set at about $500 per activity.
"Peanuts",
you say, "It costs more than that to prepare the talk and
to employ a locum"
But,
$5000 for a series of 10 venues makes it a profitable way to see
the country, meet the people (rather than just see the sights),
promote pharmacy and be sure of invitations to return.
I am absolutely sure that a similar plan would work in the city.
I
believe that we won't always be able to rely on customers bringing
us prescriptions to make up, and I also believe that counselling
after dispensing the script is perhaps just a sweetener. We need
to get out into the community, to promote ourselves, to provide
primary health-care, to make customers want to come to the pharmacy.
Pharmacy
is not well represented in planning health services.
We need to become indispensible at the grass roots level providing
support to other health professionals, and also providing strong
feedback to our pharmacy organisations and local, state and national
health planning bodies.
Your
initial comment, "That's all very well for hospital or consultant
pharmacists" is pertinent.
BUT, it is your customers that they are dealing with.
We could find the sale of medicines being undertaken in supermarkets
and all the interesting clinical bits taken over by the hospital
pharmacists, consultants or medication reviewers.
The past closures of pharmacies in rural towns provides an environment
where this can easily happen.
Financial
constraints may also have an effect - a huge outlay to purchase
a pharmacy compared to no outlay and regular income as a consultant.
Perhaps
there is a place for closure of rural pharmacies - and/or amalgamation
with super pharmacies in the larger regional towns. This is reality
- but again, I believe a stop-gap solution unless the super-pharmacies
are prepared to invest in consultant pharmacists to provide clinical
services in the denuded small towns.
I
am sure that my city counterparts have similar opportunities in
residential care facilities, community health centres, and with
other health service providers.We
have the opportunity to really expand and develop the profession
of pharmacy - but sadly, this is not really appreciated by those
suffering from the "four wall syndrome".
I'll
be a tad more optimistic next issue!
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