pharmacists future contribution to health care prof charlie benrimoj pro-vice chancellor (strategic...
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Pharmacists Future Contribution to Health Care
Prof Charlie BenrimojPro-Vice Chancellor (Strategic Planning) & Prof of Pharmacy
PracticeFaculty of Pharmacy
Peppers Salt Resort Sept 2006
Practical Application for Pharmacy
• Where will your business be in 5 to 10 years time ?
• Where will your professional practice be in 5 to 10 years time ?
• Hypothesis: Commercial and professional future of pharmacy dependant of future of health care
Change of Retail Philosophy inFront of Shop – lack of strategic
approach
• Cosmetic retailing improvements have occurred but not the underlying mix of products and approach– Low cost lowest price etc
– Volumes protected by PBS growth and monopoly of S2/S3
Change of Philosophy in Front of shop
• Intellectually stagnant for decades
• Improvements on old models of retailing
• Copying of retail models – is that appropriate ??
I
Value Proposition for Community Pharmacy – Global
Pharmacy to Optimize its value to the health (wellness) and disease (quality of life) of the community
Predict Future of Health ?
• Based on– Existing knowledge and trends– International health systems– Australian health care systems– Australian population– Major demographic changes– Major disease changes– Major service changes
• High Probability
The Shape of Our Future – Change management project (RFT 2003 -06)
• Uptake of prevention and self-management
•Changing community expectations
•New technology•Costs•Safety and quality
•Demography•Disease patterns•Changing health needs of the population
•Management of the system
•Use of ICT
TOP 10 Predictions
Future Certainties: Disease Patterns
Multiple disease states Disease changing definition Increased medication as a treatment modality Better detection of disease and risk factors
e.g. Diabetes Prevalence: 3.4% (1981) to 7.2% (1999-2000)
Underlying trends in risk factors (obesity, physical inactivity, impaired glucose tolerance)
Better management leading to longer survival
Source: AIHW (2004). Australia’s Health. Canberra: AIHW
Changing Community Expectations
• Increased demand for health information• Living longer with chronic disease
– Wish to have control over their life– Increased involvement in decision making
( evidence based)– Expert in dealing with disease– More than one health care practitioner
• Accessibility – more choice and flexibility
Demographic Changes & Disease Patterns & Consumer expectations
• No of people with complex chronic disease will increase.• Many will be elderly and have multiple health problems• Shift to self management• Involved in decision making• Increase to health promotion and disease prevention
(increased demand for screening)• Increased demand for access to health services at
convenient locations and at times that do not clash with work, educational or domestic responsibilities
• Increased safety and quality
Safety and Quality
• “Simply being a patient in an acute care hospital in Australia on average a 40 fold increase greater risk of dying for the care process than from being in traffic.” (1)
• Probably safer to travel by plane than to enter hospital due to systems
• Serious deficiencies in Hospital and Aged care system– 1/6th associated with adverse events, during or
before hospital stay (2)
• Drug related problems in Community
(1) Australian patient safety foundation 2001 (2) Wilson et al 1999
Detection of Drug Related Problems
Range of Interventions or drug related problems
CMI
Clinical Interventions
Domiciliary Medication Management Reviews
Residential Medication Management Reviews
Disease State Management
S2 and S3 Pharmacy Medicines
Major Business and Professional Opportunity
• Increased medicine usage and service requirements as result of increase prevalence of chronic disease and age of population
• Better Quality Control Systems• Different type of consumer due to increase
in self management and decision making• Increased specialization
– Businesses market niche– Professional Practice
Critical Questions
• How have we reacted ?
• Are we passive or creating our future ?
• Are we adapting out retailing and positioning our business?
• Are we evolving professionally ?
How have we reacted so far ?
• Predominantly two trends– Guild government agreements– Banner group development by wholesalers– Banner group developments by independents– Individual practitioners “innovators”
• LACKING SYSTEMATIC APPROACH
Professional Services 2000-10• Medication information (CMI) 3• Clinical interventions (DRG) • Abridged review in pharmacy (4)• Administration aids (4)• Residential medication reviews (RMMR) 2• Domiciliary medication reviews (HMR/DMMR) 3• Disease state management (DSM) 4• GP pharmacist in surgeries • Specialist CPS areas – e.g. mental health, genomics,
genetics• Pharmacist Prescribing
No. Guild/Government agreements
Translating the Value into Business Proposition
• Service delivery to:
CMI – users of medications
HMMR – 5 prescription items or more
DSM – chronic users of medications
QCPP – quality of infrastructureHigh expenditure consumers
Customer loyalty - Increase traffic flow
Product mix in front of shop
PBS and Health position
Future HealthCertainties
Changes in health
care
Opportunities for
community pharmacy
Selectopportunities
Characterizeopportunities
Consequencefor
Pharmacyand
others
Systematic Approach
Combined
In spectrum of
health care
In spectrum of
client/ professional
engagement
In spectrum of
service type
Community
pharmacy’s
professional role
Service setting Resources
Prevention
Early detection
Diagnosis and
assessment
Treatment
Rehabilitation
Palliation
Self- care
Service delivery
Retail
Professional
Novel service
being provided
by community
pharmacy
Supplementation
by community
pharmacy of
service provided
by others
Substitution by
community
pharmacy of
service hitherto
provided by
others
Options include:
1. Shop
2. Other
professional
premises
3. Mixed (1) & (2)
pharm only
4. With other
professionals
(1)- (3)
5. Patient’s home
6. Nursing home
7. Others
Skills
1. Basic
education
2. Continuing
education
3. Training
Incentives
Infrastructure
Frommer, Roberts and Benrimoj 2004
1. Spectrum Of Health Care
•Prevention •Early Detection Diagnoses and Assessment
•Treatment•Rehabilitation•Palliation
2. Spectrum of Engagement
SelfManagement
ProfessionalCare
Delivery
3 & 4 Pharmacy Activity and Remuneration
ProductSupply
Service
Consumerpayment
ProductAnd
Service
Governmentpayment
Health insurancePayment
Any Combination
Community Pharmacy & Pharmacist Roles
Supplementationof Service by
other Provider
Loss of RoleRegaining Role
previously Taken by Others
Novel Serviceor Product
Substitutionof Service provided
by Others
eg Immunization
eg HMR
eg Diabetes education
eg Nutritioneg Herbal medicines
Service Setting
Retail
OtherProfessional
Premises
Patients Home Nursing Home
E- Pharmacy
Schematic ViewDispensary - Prescriptions Pharmacy Only and
Pharmacist Only products (Primary Care)
Departments or Categories, Health and beauty
Philosophy - Strategic Framework• Dispensary (chronic diseases)• Pharmacy Only and Pharmacist Only
products (Primary Care)• Front of shop (prevention and
wellness)
Outcome: increase revenues and reverse trend on governmental dependence with mix of product and services
INTEGRATIon
Pharmacy Viability Matrix
Focused Specialities Multi Specialties
Traditional Pharmacy Pharmaceutical Superstore
COMMUNITY SCOPE
EXTENDED
LOCAL
NARROW BROAD
PRODUCT/SERVICE CHOICE
Core Pharmacy Product & Service
The Shape of Our Future – Change management project (RFT 2003 -06)
Traditional Pharmacy
Focused Specialties Multi specialties
Traditional Pharmacy
e.g. UTS pharmacyPharmaceuticalSuperstore
COMMUNITY SCOPE
LOCAL
Traditional Pharmacy
Provides local consumers with a focused supply of traditional pharmacy products and/or services. They are the front-line of health care within their community
NARROW BROAD
CUSTOMER PRODUCT/SERVICE CHOICE
EXTENDED
Specialties
e.g. compounding Multi Specialties
Traditional Pharmacy PharmaceuticalSuperstore
LOCAL
Focused Specialties
Provide a small number of specialised and alternative products and/or services to a focused niche “patient” market that extends beyond their local community.
NARROW BROAD
CUSTOMER PRODUCT/SERVICE CHOICE
EXTENDED
COMMUNITY SCOPE
Focused SpecialtiesMulti-service specialties
e.g. Fresh Therapeutics E-Pharmacy
Traditional Pharmacy PharmaceuticalSuperstore
COMMUNITY SCOPE
EXTENDED
LOCAL
Multi Specialties
Offer a range of highly specialised health-care solutions to an extended market. These products and/or services are not “generic” and their product and/or service range is difficult to imitate.
NARROW BROAD
CUSTOMER PRODUCT/SERVICE CHOICE
Conclusion - Future
• Great opportunities in Health Care for Pharmacists and Pharmacy
• Rate of Change is the question moving from old traditional ways of retailing to more sophisticated approaches
• Retailing of Goods to Retailing of Goods and Services