..Information to Pharmacists
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    Your Monthly E-Magazine
    July, 2002

    Published by Computachem Services

    P.O Box 297.
    Alstonville. 2477
    NSW Australia

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    AYRON TEED

    From a Rural Hospital Perspective

    A Tribute to a Division of General Practice

    The last few editions of this story illustrated the many small events that culminated in this aged pharmacist without any community pharmacy experience purchasing a really remote Victorian pharmacy.
    This edition will explain the reasons for the success of the venture.
    The purchase of the pharmacy was really a challenge - to change the concept of pharmacy practice in rural areas.


    The problems - lack of locums, difficulty with gaining useful Continuing Education, lack of peer support, inability to leave the premises during business hours, distance from all the friends and activities enjoyed during university years and so on ad nauseum.

    My previous attempts to improve the situation through existing hospital and community pharmacy channels were not successful. There is a real barrier to communicating when the parties cannot grasp the back-ground to the problems. City-based pharmacists and trainees have to experience rural practice to understand the broader concepts.

    The next step was to look for local solutions. Not pharmacy solutions, because there was no avenue at that time for addressing these issues. However, there was real concern in government circles about health services in rural areas. And, if pharmacists could have interacted more easily with the other health professions, they would have discovered that our problems were common to all.

    The local Division of General Practice already had in place procedures for recruitment and retention of rural doctors. This included support for locum practitioners, information kits on the various practices in the rural towns and a positive approach to the problem. It also wanted to increase its activities through government funded projects.

    So, the purchase of the pharmacy at Rainbow and my determination to restructure the pharmacy activities in the town (and also the neighbouring town of Jeparit) provided the basis for a RHSET project over two years. The project also included some preliminary investigations into using video conferencing to help patient counselling in pharmacy depots.

    The initial project paid for a project manager at the Division for two days each week. This was a really innovative project for the Division of General Practice. A pharmacy project in a medical organization.

    The project manager, Mrs Jane Measday was not a pharmacist. This was an advantage - she questioned every aspect of our activities in the community pharmacy. And, because of this it became increasingly clear that we had to look at our priorities, move outside the "four walls" of pharmacy and focus on positive outcomes. We knew what a pharmacist was, but that didn't necessarily correspond with what she or the GPs understood!

    The Division provided the secretarial assistance, and funded monthly teleconference sessions for all the pharmacists in the region. It also funded a fortnightly Pharmfax, an A4 newsheet faxed to all interested pharmacists.

    Examples of the Pharmfax can be viewed at www.westvicdiv.asn.au - click on the rural pharmacy icon.

    These initiatives have continued after the project was concluded.
    The Division continues to provide funds and secretarial assistance.
    Towards the end of the project there was another rural pharmacy in danger of being closed.
    The Division of General Practice provided the support for that community to retain their pharmacy - in a similar way to the Rainbow story.

    The Division then successfully obtained funding for another two year project looking at GP/Pharmacy Liaison. For this project it employed a pharmacist part-time. This project was also extremely successful - with a focus on the common interest areas shared between doctors and pharmacists.

    These included medication use and poly-pharmacy, drug seeking behaviour, primary health care, specific disease counselling and health promotion. Group discussions and problem solving case studies began the process of breaking down the barriers between GPs and pharmacists.

    This project concluded at the end of 2001.
    In February this year the West Vic Division of General Practice produced a "How To Kit" which was sent to every Division of General Practice in Australia.

    The kit contains a series of fact sheets.

    These two projects helped form the basis for the National DMMR facilitators within the Divisions of General Practice, and in our Division a further increase in pharmacists employed. We have an advantage in the West Vic Division in that the facilitator has been involved in all the ground-work and relationship building between GPs and pharmacists. The pharmacists are already meeting as a pharmacy group - sharing concerns, and discussing case studies. The group includes all pharmacists - locum, community, hospital and consultant. Some join in by teleconference, with the others at the Horsham or the Ararat Division offices.

    The next project, just commenced is the provision of a locum pharmacy service for the region.
    The Division is coordinating the service, with the Pharmacy Group providing input into the project.
    The project pays for travel and weekend accommodation expenses.
    The pharmacist pays the locum's wages.

    As an aside, I am really sad that so many of our "four wall syndrome" sufferers have not even grasped the fact that employing a locum for a week - just to be free to leave the premises and be seen in the street, is very therapeutic.

    In conclusion, I never cease to be amazed at the results of saying "OK. but......" when I was asked to purchase the pharmacy at Rainbow.
    Also, I never cease to be amazed at the generosity and support extended to pharmacists by the West Vic Division of General Practice.

    Our pharmacists used to whinge about locums, CE, cost of becoming accredited to do medication reviews - a bit like farmers and the weather!
    But not any more.
    Amazing!!!!

    And, that's your lot for this month.

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