Debbie Rigby

The future of professional

practice: why standing still
is not an option
Topics

Evolution
Evolutionof
ofpharmacy
pharmacypractice
practice

Drivers
Driversfor
for practice
practicechange
change

Change
Changemanagement
managementstrategies
strategies

Benefits
Benefitsof
ofprofessional
professionalservices
services

Future
Futureroles
rolesfor
forpharmacy
pharmacy
Pharmacy is living on the edge!
 Paradigm shift

Service providers with a retail element,

rather than retailers with a service
element

Differentiate - innovate
 compounding
chronic
disease self-
management

Evolution of dispensing
disease
state
pharmacy practice
management

pharmaceutical
care

comprehensive
medication
reviews
 Evolution of pharmacy practice

Shift to pharmacists being directly responsible
for outcomes, quality of care, quality of life and
directly responsible to the patient

Change from product-orientated focus to patient-

orientated focus

‘risk-takers’ or innovators
 Pharmaceutical care

pharmaceutical care is a patient-centered,

outcomes oriented, pharmacy practice.

pharmaceutical care is the responsible

provision of drug therapy for the purpose
of achieving definite outcomes that
improve a patient’s quality of life

Hepler CD, Strand LM. Opportunities and responsibilities in

pharmaceutical care. Am J Hosp Pharm. 1990;47:533-543.
 UK experience

MURs (medicines use review)

establish patient’s actual use,
understanding & experience

identifying, discussing and resolving
poor or ineffective use of drugs

identifying side effects and drug
interactions that may affect
compliance

improving clinical & cost effectiveness
of drugs – reduce wastage

Max. 250 per pharmacy pa @ £25

 Canadian experience

Meds Check, a medication review program, as
the first professional service available under the
Ontario Drug Benefit Program that began April 1,
2007

one-time payment of $1,000 to pharmacies once they

have initiated the service to support pharmacists in
implementation

$50 per service for annual review in patients taking 3

or more chronic prescription medicines

aim: to maximise patient adherence to drug therapy

Australian experience - 2002

n=1131

IJPP 2007;15:185-191
 Professional services

prior
prior to
to 1997
1997 1997
1997 -- 2007
2007 --

Prescription Clinical
Adherence
review & medication
services
dispensing reviews
Topics

Evolution
Evolutionof
ofpharmacy
pharmacypractice
practice

Drivers
Driversfor
for practice
practicechange
change

Change
Changemanagement
managementstrategies
strategies

Benefits
Benefitsof
ofprofessional
professionalservices
services

Future
Futureroles
rolesfor
forpharmacy
pharmacy
“Our long-term function doesn’t lie in that area
(supply function and price). It lies in cognitive
services”

John Bronger
President, Pharmacy Guild

Grist J. Pharmacy gets a B for effort. Pharmacy News 2002;4 April:2

 From pyramid to coffin

Changing age structure of the Australian population, 1925-2045

Age
80 1925 2000 2045

70
60 females
males females males males females
50

40

30
20

10

0
1.2 0.6 % 0.0 0.6 1.2 1.2 0.6 % 0.0 0.6 1.2
1.21.2
1.2 0.6 % 0.0 0.6 1.2

Productivity Commission 2005, Economic Implications of an Ageing Australia,

Research Report, Canberra.
 “Ageing is us”

By 2044-45 one in four Australians will be

‘old’ (65 years or more) — double the
present share.

At that time, the old will comprise around 7

million Australians, up from the present 2.5
million.

Productivity Commission 2005, Economic Implications of an Ageing Australia,

Research Report, Canberra.
 Chronic disease burden

60-70% of patients in pharmacy have
chronic disease

Obesity more consistently associated with

chronic illnesses such as diabetes, heart
disease and asthma than smoking or
alcohol use

Community pharmacists must position themselves

to meet the needs for chronic disease management
 Chronic disease

diabetes prevalence doubled over last 20 yrs

asthma – 14% children 10% adults

arthritis – 3 in 10

cardiovascular disease – 1 in 5

cancer – 2nd leading cause of death

mental health – 13% of disease burden

OPPORTUNITY
 Intergenerational Report

in 40 years the Government will spend an

average $2200 per head on medicines
each year, six times today's bill
 Change drivers

consumer expectations

technology

ageing population

increasing burden of chronic disease

 Change management
We can anticipate change, initiate it, and
implement it, or we can let it happen to us,
and respond to it. Either way, the change
keeps moving.

“Adapting to change is necessary

in order for improvement or
progress to occur.”
Topics

Evolution
Evolutionof
ofpharmacy
pharmacypractice
practice

Drivers
Driversfor
for practice
practicechange
change

Change
Changemanagement
managementstrategies
strategies

Benefits
Benefitsof
ofprofessional
professionalservices
services

Future
Futureroles
rolesfor
forpharmacy
pharmacy
 Impact analysis

What is your current situation?

What is the impact of your current

situation?

What is the ideal situation?

What would be the impact of the ideal

situation?
 What makes us indispensable?

Supply 

Front shop 

DAA packing 

Drug information 

HMR, RMMR 

Individualized drug information 

Drug expertise (QUM) 

Health Professional accessibility 
 Change management

Cannot continue to rely on Am I

ready for
dispensing change?

Shift towards services

Point of differentiation

To meet the challenge of

change, need the tools to
implement the change
 Change management

..there has never been a better

time for pharmacies to rethink
their approach to business. By
providing services and linking
these to product sales,
…pharmacists can not only
ensure a profitable livelihood, but
also contribute to better overall
health for the community

Source: PricewaterhouseCoopers
Topics

Evolution
Evolutionof
ofpharmacy
pharmacypractice
practice

Drivers
Driversfor
for practice
practicechange
change

Change
Changemanagement
managementstrategies
strategies

Benefits
Benefitsof
ofprofessional
professionalservices
services

Future
Futureroles
rolesfor
forpharmacy
pharmacy
 Management of change

Benefits cannot be achieved without

change

Change cannot be sustained without

benefits
 Community pharmacy benefits

trust

accessibility

medicine experts

reduced health costs

better health outcomes for consumers
through better use of medicines
Different & important

(McKinsey Quarterly - May 2004)

Change management

Dexter Dunphy et al. The Shape of Our Future. Change

Management and Community Pharmacy Project. 2005
Price promotion
What message does it send to consumers?
 Diabetes patient
Monitoring
Administration
Diabetes Rx equipment
Aids eg DAAs

Antihypertensive Wound
Rx management

Other Rx
Lipid Rx Foot care
eg aspirin, NRT,
weight loss
 DMAS
Leverage per patient per annum

Sales (Rx, OTC, etc)

$5,000

Gross profit dollars (32%)

$1,600

DMAS – gross income per patient

$458

Total income dollars

$2,058

Gross income for 14 patients p.a. = $28,812

 Value of a loyal customer

Consumer loyalty

DMAS DAAs & OTHER

HMRs
& asthma Med Profiles SERVICES
Topics

Evolution
Evolutionof
ofpharmacy
pharmacypractice
practice

Drivers
Driversfor
for practice
practicechange
change

Change
Changemanagement
managementstrategies
strategies

Benefits
Benefitsof
ofprofessional
professionalservices
services

Future
Futureroles
rolesfor
forpharmacy
pharmacy
 Professional services

2CPA 3CPA 4CPA Future

QUM services Pharmacist

RMMRs HMRs prescribing
DAAs CDSM
QCPP Medication Specialist services
profiles Health promotion
CMI & prevention
DSM
e-Health
Hep C Pharmacovigilance
 4th CPA Professional Pharmacy Programs &
Services
Medication Management Review

Home Medicines Reviews

Residential Medication Reviews

Accreditation incentives

MMR Facilitators
Indigenous programs

ATSI pharmacist scholarships

ATSI pharmacy assistant scholarships

S100 allowance

Improved access programs
Better Community Health

QCPP, R&D & eHealth

Asthma & Diabetes

DAAs

Medication profiling

Practice change program

Communicable diseases, EHC counselling
Rural Programs

Rural Maintenance Allowance

Start up / succession allowances

Pre-registration incentives

Rural workforce program
 Professional Pharmacy Service Continuum

Increasing pharmacist Assisting

time / cost due to patients and
complexity of service / GPs in
Quality Use HMRs & Disease
patient of Medicines Residential State
Medication Services Monitoring
Medication
Assistance to remote and
Reviews
Medication Services Aboriginal Management
Clinical Dose Profiling (Diabetes Medical
Interventions Admin Services and Asthma) Services
Consumer for identifying Prescribing Aids (DAAs)
Medicines Drug S2 / S3
Medication Information Related
Dispensing (CMI) Problems

$500 service
10¢ incentive for
~$10 ~ $25-$30 $320 - $400 $6 - $10k p.a $180 & $130
per CMI
? 5 CPA
EHC per week per service per service + $3k travel
per service
? 5 CPA
+$12.50- $7.50
+co-payment +$5 co-payment
Counselling? co-payment

$1,080 (HMR)
$4,000 $500 p.a?? ~$7,000 ~$3,000 $8,730
$3,300 (RMMR)
 Professional services

smoking cessation
adherence monitoring

weight loss
assistive technology

INR testing
chlamydia testing

BMD testing
immunisation

cholesterol tests
continence care

BP monitoring
chronic disease self-

wound care management

compounding
disease state Mx

pharmacovigilance
pandemic planning

prescribing
pharmacogenomics
INR monitoring
 Genetic polymorphism

AmpliChip Cytochrome
P450 Genotyping
Test

analyses CYP2D6 and

CYP2C19 genotypes
 Chronic disease

diabetes prevalence doubled over last 20

years

asthma – 14% children 10% adults

arthritis – 3 in 10

cardiovascular disease – 1 in 5

cancer – 2nd leading cause of death

mental health – 13% of disease burden

= OPPORTUNITY
 Preventable risk factors

Lifestyle changes

smoking

alcohol use

physical inactivity 1/3 of chronic disease
burden attributed to

poor diet & nutrition these risks

excess weight

high blood pressure

high blood cholesterol
 Health care providers role

reducing risk

early identification of disease

managing acute conditions

long-term care

care in advanced stages of disease

Where does community pharmacy fit in?

 Chronic disease self-management

self-management enhance patient

responsibility for own health & with support
of pharmacists, make informed decisions
and better management to improve well-
being and quality of life

optimising self-management is essential

for achieving patient-centred care
 Consultation room

“Community pharmacy is
changing. With pharmacists’
clinical advisory role coming to
the fore, pharmacy premises in
the community are having to
change, too. This is
demonstrated by the
proliferation of consultation
areas in pharmacies throughout
the UK.”

Pharm J 2007;279:225
Professional counselling room
 What does
the future hold?
 Time for pharmacy to move on

move on from their 'old' ways of selling unprofitable but traditional
pharmacy lines such as gifts and toiletries.

pharmacies should be implementing the range of cognitive services

now available in some cases (eg HMRs and RMMRs) and soon to
be available in others (eg asthma and diabetes disease state
management programs, medication profiling and dose
administration aids assistance).

persuasive business case, clearly justifying the introduction by

pharmacies of these services - income generated from these
services was, in fact, only the tip of the iceberg as there are a whole
range of complementary goods and services that pharmacies might
provide to their patients.

"If pharmacies don't quickly convert to health solution providers,

they can blame no-one but themselves for their failure."

Bruce Annabel PAC 2007

 Time for pharmacy to move on

“If pharmacies embrace solution marketing and actually bite the
bullet and forego many of the non lucrative and costly categories
such as gifts and toiletries, there will come a time when the
pharmacy of tomorrow need not have to occupy as large a footprint
as they do today. A substantial reduction in floor size could mean a
substantial reduction in rental outgoings and could be the difference
between a fair ROI and a good ROI. Coupled to this their stock
investment would reduce with all the logical flow on benefits. I see a
new practice and financial model for pharmacy emerging. It will be
interesting to see who treads this path first.”

AusPharmList 29 August 2007

 Time for pharmacy to move on

“Imagine having 2 pharmacists and doing 350 scripts a
day as well as trying to provide these services as well…..
It's a nice idea and something we should be working
towards, but I don't see a place for it in today’s pharmacy
except for exceptional circumstances. There needs to be
suitable training programs in place and foreseeable
income for it to become more common.”

AusPharmList 30 August 2007

 Put the “pharmacist”
into pharmacy

Knowledgeable, personal, EBM, QUM,

approachable, accessible

and makes money!

 Skills, knowledge & attitude

Excellent communication skills

Innovative attitude

Willingness to overcome barriers

Confidence in knowledge base and role of
pharmacist in medication management

Good listener and learner

Specialised knowledge eg geriatrics,
asthma, diabetes
 Professional services

Today’s opportunity, tomorrow’s

imperative!