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Should pharmacists get $50 to give you a health check?

The Pharmacy Guild has proposed a scheme that would see the Commonwealth government pay pharmacists A$50 to provide one-off health checks. Pharmacists checks would assess patients' body mass index, blood…

Pharmacists' skills go well beyond dispensing drugs but a one-off check would do little to achieve integrated care. Image from shutterstock.com

The Pharmacy Guild has proposed a scheme that would see the Commonwealth government pay pharmacists A$50 to provide one-off health checks. Pharmacists checks would assess patients' body mass index, blood pressure, blood glucose, cholesterol, and ask about lifestyle risks such as smoking and alcohol intake, to identify patients at risk of chronic diseases.

The prospect of saving money on GP visits might, for a moment, sound appealing to a government looking to save on health spending. But while pharmacists do need new roles, this should not be one of them.

Community pharmacy under pressure

There is a series of looming threats to the traditional community pharmacy.

The Guild claims that price cuts announced by the Commonwealth in August last year could drive some pharmacists out of business. But as Grattan Institute reports have shown, even after these cuts, Australia’s wholesale prices are still far too high. For many drugs, the government still pays more than ten or 20 times the prices in New Zealand or the UK. These inflated prices cost taxpayers about $1 billion a year, as well as hitting consumers directly.

With the government searching for savings, inflated drug prices are a very good place to look. If Australia gets competitive prices, it would have a big impact on pharmacy income.

There is also increasing scrutiny on deals between pharmacies and drug companies, with the Australian Competition and Consumer Commission taking a drug company to court over discounts it gave pharmacies.

Finally, there is growing competition from discount pharmacies and supermarkets. In 2011, Terry White of Terry White Chemist saw many of these changes coming:

Pharmacists are going to cop it both ways. There’s the hit in the margins coming from back-of-shop and increased competition for sales in front-of-store. I have never seen it this tough.

Using pharmacists' skills

The bulk of government payments to pharmacists are mark-ups on drug prices. The more drugs pharmacists dispense, and the higher the price, the more money pharmacists make. For the most part, we’re paying them as retailers.

Yet, as many other countries have realised, pharmacists shouldn’t be valued by the cost of the pills they sell. They are trained for four years about drugs and their impacts. They know how to dispense drugs safely and provide advice on medicines. They are a highly trusted group located throughout Australia, including in areas with low access to primary health care.

People can usually see a pharmacist immediately. In many parts of Australia, this can’t be said of GPs. In cities, more than one in eight people report waiting too long to see a GP. In regional and rural areas, it’s about one in five.

In Britain, Canada, New Zealand and the United States, pharmacists are used to increase access to primary care. They deliver a wider range of services, including providing vaccinations, reissuing prescriptions for long-term conditions and working as part of a team to help patients manage chronic conditions.

It’s time for Australian pharmacists to follow suit, particularly in rural areas where there is a chronic shortage of GP services.

Why not start with one-off health checks?

The Australian Medical Association (AMA) has denounced the $50 pharmacist health check proposal, arguing the direct cost to government would be higher than for a similar GP visit. That’s questionable, as GPs can bill $58 or $70 for a half-hour health check.

The AMA also raises concerns about the quality of pharmacist check-ups, fragmentation of care, and possible lack of patient privacy during pharmacy consultations.

One of these concerns is certainly valid: a one-off check would do little to achieve integrated care. It would basically leave us with the same old model, missing an opportunity to adapt to the rise of chronic disease.

A growing number of people have chronic conditions such as diabetes, arthritis and heart disease – and they’re increasingly likely to have multiple health problems. This means they need to use several different health care services, often while taking a complex array of medicines. Providing the right mix of care in a seamless way that works for patients is a crucial challenge for health care in coming decades.

To make it work, pharmacists should do more than one-off health checks with no real link to other kinds of care. GPs should remain at the centre of the system, referring patients to other kinds of health worker as needed.

Making this change won’t be easy. Better patient records, training that helps different disciplines work together, and the right financial incentives and quality assurance will all help. While there are challenges, other countries have already done this, and there is evidence that patients benefit when pharmacists contribute to team-based care for chronic disease.

The Pharmacy Guild is clearly looking for new ways for its members to earn an income. That’s fine if it makes the whole system work better. But a one-off health check that doesn’t take broader issues into account won’t do that.

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31 Comments sorted by

  1. Jay Wulf

    Digerati at nomeonastiq.com

    I love this idea!

    We would save money on health costs, and also address the communist, pinko red square IMF insistance on spending tax payers money on health and education which this administration considers extravagant.

    In this spirit here are some other suggestions I came up with over a cuppa of coffee, which is by all appearances an extended study, well over 200% longer and more exact that the brainfart that caused this 'great idea'.

    So here is my list of other options available to this…

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    1. Suzanne Cartwright

      Clinical Fellow, Anaesthesia and Pain Management

      In reply to Jay Wulf

      How would this save money?

      Level B consultation (standard GP consult requiring, according to the medicare benefits schedule):
      "Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:
      a) taking a patient history;
      b) performing a clinical examination;
      c) arranging any necessary investigation;
      d) implementing a management plan…

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    2. Jay Wulf

      Digerati at nomeonastiq.com

      In reply to Suzanne Cartwright

      Have you read 'A modest proposal?', I thought it was compulsory reading for all Chefs, err... Medical staff.

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    3. Suzanne Cartwright

      Clinical Fellow, Anaesthesia and Pain Management

      In reply to Jay Wulf

      Hmm, that would be my stupidity in hitting the wrong button on the comment thread. Now discovering I can't move it either. Note to self - no trying to reply on using phone screen.

      So point most definitely taken!

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  2. John Crest

    logged in via email @live.com.au

    Maybe we can get the person behind the counter at 7/11 to do it for $40?

    Cheaper and about as useful.

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  3. Ben Marshall
    Ben Marshall is a Friend of The Conversation.

    Writer

    The idea of giving primary health care to pharmacists is so terrible, on so many levels, I am absolutely confident the Coalition will grab it with both hands.

    It doesn't matter about the raging conflict of interest, or finding a way to host primary health care in a crowded shop, it'll save money!

    Actually, not. Want a better idea using existing infrastructure? More practice and community RNs and midwives, working in concert with GPs, hospitals and social welfare. Provides more and easier…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Ben Marshall

      How about a trade:

      Pharmacists get to do a few simple checks for $50, and in return agree to get rid of all the non-therapeutic ''supplements'' from their shelves.

      Deal?

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  4. Daniel Rifkin

    logged in via Twitter

    In the US and UK both government and private health funds pay for pharmacists to provide health checks, health screens, immunisations and medicine use reviews. Pharmacists are a vital part of the health infrastructure and see patients in the community that often do not see their GP.

    Pharmacists are the most accessible primary healthcare professional. No appointment required, open long hours, and are in every electorate in Australia ensuring the safe and timely access to medicines and health advice…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Daniel Rifkin

      As I understand it, GPs' concerns about immunisation are not about ''turf'' but about safety for the rare allergic reaction, which would require identification and treatment by a clinician.

      In the community, a large number of immunisations are given by practice nurses or nurse immunisers, within a health care environment.

      Certainly pharmacists are highly trained professionals but their training is in pharmaceutical science, not clinical science.

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    2. Daniel Rifkin

      logged in via Twitter

      In reply to Sue Ieraci

      Thanks Sue, I enjoy your comments, and wish to provide some information with regards to your reply.

      Pharmacy students at Charles Sturt University undergraduate Bachelors of Pharmacy degree complete a clinical focused course in immunisations. Pharmacists embarking on immunisations in the community will have completed further training to ensure patient safety and competence in practice.

      GP concerns re: Allergic reactions are a real concern. Managing allergic reactions is well well within the…

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    3. Sam Han

      Lawyer; LLM student

      In reply to Daniel Rifkin

      I guess it's less about defending turf, and more about how there are no formal training and credentialling programs for pharmacist immunisers in Australia. The PSA has made some guidelines, but immunisation (including patient screening) and response to adverse events are not required learning in all BPharm programs. The UQ program for example, has no such content, not even as an elective.

      Objections to pharmacist-immuisers could be rebuffed by having such a system across the country, rather than per jurisdiction or per university program.

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    4. Rosemary Stanton

      Nutritionist & Visiting Fellow at UNSW Australia

      In reply to Daniel Rifkin

      Daniel

      I accept that pharmacists are trained professionals but if so, why do they not realise that products they sell such as vitamin waters are basically cordial, fat-blasters are totally shonky and many of their herbal preparations have no efficacy and lack standardisation. I also wonder if they are concerned that many of the vitamins they sell contain quantities that have little relationship to the recommended dietary intakes. Do they perhaps ask their suppliers to provide iodine in the quantity recommended for pregnancy without the iodine being accompanied by a range of vitamins that are not needed, but which the price of the iodine supplements beyond the reach of many pregnant women.

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    5. Anthony Tassone

      President, Pharmacy Guild (Victoria Branch)

      In reply to Sue Ieraci

      Hello Sue

      Your comments and concerns are very reasonable and have been recognised, and addressed by the Pharmacy Board of Australia. In a recent communique in December 2013 which is shown below:

      Vaccination

      The Board noted the work undertaken on its behalf by the Advanced Practice Framework Steering Committee and has advised that in its opinion vaccination is within the current scope of practice of a pharmacist. However, further work regarding competence to do so, standards, training and…

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    6. Sue Ieraci

      Public hospital clinician

      In reply to Anthony Tassone

      Thanks, Anthony

      Ideally, all health professionals would work collaboratively, as they do in hospital, without the pressure of running a small business or having to juggle professional duties with retail. Each profession can contribute knowledge and tasks - medicine, nursing, physio, speech pathology, laboratory scientists, transport people, clerical and admin staff - they all contribute to the work to be done. Under those conditions, pharmacists aren't asked to administer medication because their…

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  5. Jeremy Culberg

    Electrical Asset Manager at Power Generation

    One service that would be good for pharmacists to perform is a comprehensive review of all prescribed medications the patient is on. Many older patients are on multiple prescriptions - during one study I was involved with (post hospitalisation compliance), the normal number was 6, with some patients having up to 20 prescribed medications. In some cases, the number of medications could be rationalised - three pills down to one combination pill. In other cases, adjusting the timing of certain medications…

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    1. Tracy Soh

      Addiction Medicine Physician at Eastern Health / Turning Point Alcohol & Drug Centre

      In reply to Jeremy Culberg

      This service already exists - it is called Home Medication Reviews (HMRs). Unfortunately, the Pharmacy Guild has lobbied the Government to REDUCE access to HMRs capping the number of reviews each pharmacist can perform to 20 per year, and having a minimum of 2 years interval between reviews for each patient.

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    2. Jeremy Culberg

      Electrical Asset Manager at Power Generation

      In reply to Tracy Soh

      Tracy, I should have read the other article on the Conversation this morning regarding that before I posted. This facility may be available, however its use when I was involved in that study (2006, Tasmania, specifically Hobart) was not widely known / utilised.

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    3. Richard Churchward

      logged in via Facebook

      In reply to Jeremy Culberg

      Hi Jeremy.
      There are such programmes in place. But they were inadequately funded, prone to rorting (by both doctors and pharmacists) and have recently been hobbled by agreement between the Pharmacy Guild of Australia (sole negotiator with the government on pharmacy funding and representative of pharmacy owners only).
      Pharmacy is casting around for further roles and additional sources of income. It has been argued by many pharmacists that we have adequate knowledge to perform what appears to be…

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  6. Tom Orren

    Retired Teacher

    Would this mean Dietitians that would then be allowed to begin dispensing pharmaceuticals? While it is an excellent idea to have a general health assessment done once a year, it needs to be done by someone with the right qualifications, in particular someone who could give good follow up advice about diet. That is, Dietitians, not Pharmacists. Health services should not just be another way to make money, they need to be taken seriously and done by appropraitely qualified professionals.

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  7. Julie Fechner

    Retired (Grumpy old woman)

    No No No No No Had to repeat five times as I needed 10 characters.

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  8. John Stafford

    Wellness advocate

    I don't think that the pharmacist is the right answer to the obesity problem but it is a far better option than doing nothing or whatever it is that the GPs have been doing that leaves us with an adult population where 60% are overweight or obese and therefore at increased risk of chronic disease.

    What we really need is a new form of primary health care provider where GPs, pharmacists and allied health practitioners led by dietitians and psychologists/lifestyle coaches operating together as an…

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  9. Murray Barson

    GP/emergency doctor

    This might be useful in identifying new diabetes, high BP, or treatable levels of cholesterol, but getting someone with a chronic health problem to understand a random numerical value in the context of his/her individual health needs, and to develop a plan that is rational, sustainable, acceptable and appropriate is a complex ongoing project.

    False reassurance is one unhelpful possible outcome. An acceptable result for a random non-fasting total cholesterol, for example, is context-dependant…

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  10. Gary Cassidy

    Monash University

    How was the $50 fee established? I'd be interested to know how much profit would come from each "Health Check". A rolling door health check centre that takes 10 minutes per visit could be a real money spinner. At the end of the day the patient would probably just get a piece of paper that they would need to take and discuss with a trained GP.

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  11. Michael Mihajlovic

    Retired

    If we are going to get Pharmacists to do the GP's and their Nurses' work, what will we do with the GP's and their Nurses? Make them redundant?
    Shouldn't the AMA makes those tasks the GP's responsibility?

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  12. Kerry List

    Writer

    Even the college of GPs in Australia regards health checks as pointless and leading to a false sense of security.

    They are useless.

    The point of having different professions, e.g. doctors and pharmacists is that together, the roles become corrupted.

    "Here, have this quack tonic that I just made, It's only $500"

    It is by our different roles that we specialise, and generate checks and balances on each other, leading to better patient outcomes.

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    1. Tom Orren

      Retired Teacher

      In reply to Kerry List

      I agree, Kerry, that one-off checks could be pointless but I can see value in annual checks by trained Dietitians that feed data into a coordinated, national data base. The individual can benefit from an objective annual assessment of their diet and society can benefit from the data.

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    2. Kerry List

      Writer

      In reply to Tom Orren

      What a lovely fantasy world.

      What about confidentiality of my data?
      Who maintains the data?
      Is the data able to be sold?

      Tom, have you done the appropriate trials to say this would actually have a benefit?

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  13. Kerry List

    Writer

    In case no one realises this... These sort of ideas are merely about diversifying the Pharmacist's roles ... as it seems community pharmacy is going down the gurgler...

    Ask the pharmacy profession how many pharmacies in Australia close each year.

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    1. Tom Orren

      Retired Teacher

      In reply to Kerry List

      If you're thinking about the data being sold, you're probably thinking too much about the private sector. Definitely not. We're long overdue for a secure, national health-record database that links GPs, specialists, medical professionals and hospitals across the country. After all, there are only 24 or so million of us, so it shouldn't be that difficult.

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    2. John Stafford

      Wellness advocate

      In reply to Tom Orren

      Tom, if you think that getting GPs, medical specialists, and hospitals to agree on a common data set and platform to collect information is easy then your skills are badly needed working for the United Nations to bring about peace in Afghanistan or the Middle East. The professions' most recent attempt - the Personally Controlled Electronic Health Record - is but the most recent proof that they cannot get an even adequate example of what you suggest up and running with public and professional involvement after years of trying.

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    3. Tom Orren

      Retired Teacher

      In reply to John Stafford

      Sadly John, I'm afraid you're right. But I am up for that UN job if anyone's listening ;-)

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