Pharmacists Future Contribution to Health Care

1. Pharmacists Future Contribution to Health Care Prof Charlie Benrimoj Pro-Vice Chancellor (Strategic Planning) & Prof of Pharmacy Practice Faculty of Pharmacy Peppers Salt Resort Sept 2006

2. 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

3. 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

4. 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

5. Value Proposition for Community Pharmacy – Global Pharmacy to Optimize its value to the health (wellness) and disease (quality of life) of the community

6. 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)

7. TOP 10 Predictions • Demography • Disease patterns • Changing health needs of the population • New technology • Costs • Safety and quality • Uptake of prevention and self-management • Changing community expectations • Management of the system • Use of ICT

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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 ?

15. 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

16. 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

17. 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 infrastructure High expenditure consumers Customer loyalty - Increase traffic flow Product mix in front of shop PBS and Health position

18. Changes in health care Opportunities for community pharmacy Future Health Certainties Characterize opportunities Select opportunities Consequence for Pharmacy and others Systematic Approach

19. Frommer, Roberts and Benrimoj 2004

20. 1. Spectrum Of Health Care • Prevention • Early Detection Diagnoses and Assessment • Palliation • Treatment • Rehabilitation

21. 2. Spectrum of Engagement Self Management Professional Care Delivery

22. 3 & 4 Pharmacy Activity and Remuneration Service Product Supply Product And Service Any Combination Health insurance Payment Government payment Consumer payment

23. Community Pharmacy & Pharmacist Roles Supplementation of Service by other Provider Substitution of Service provided by Others eg Diabetes education Novel Service or Product eg Immunization eg Nutrition eg Herbal medicines eg HMR Loss of Role Regaining Role previously Taken by Others

24. Service Setting Other Professional Premises E- Pharmacy Retail Patients Home Nursing Home

25. Schematic View

26. Philosophy - Strategic Framework IN T E G R A T Io n • 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

27. Pharmacy Viability Matrix PRODUCT/SERVICE CHOICE NARROW BROAD COMMUNITY SCOPE Focused Specialities Multi Specialties EXTENDED Pharmaceutical Superstore LOCAL Traditional Pharmacy Core Pharmacy Product & Service The Shape of Our Future – Change management project (RFT 2003 -06)

28. Traditional Pharmacy COMMUNITY SCOPE Focused Specialties Multi specialties EXTENDED 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 Traditional Pharmacy e.g. UTS pharmacy Pharmaceutical Superstore LOCAL BROAD NARROW CUSTOMER PRODUCT/SERVICE CHOICE

29. COMMUNITY SCOPE 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. Specialties e.g. compounding EXTENDED Multi Specialties Pharmaceutical Superstore Traditional Pharmacy LOCAL BROAD NARROW CUSTOMER PRODUCT/SERVICE CHOICE

30. COMMUNITY SCOPE 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. Multi-service specialties e.g. Fresh Therapeutics E-Pharmacy Focused Specialties EXTENDED Traditional Pharmacy Pharmaceutical Superstore LOCAL BROAD NARROW CUSTOMER PRODUCT/SERVICE CHOICE

31. 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