Clinical Intervention: a clinical or financial scheme?


Capsule with dollar signs spilling out

This week’s contributor wanted to remain anonymous: here, our Guest Author asks whether the Clinical Intervention scheme should exist in its current form at all

A brief overview

Let’s begin with the basics: what is a clinical intervention (CI)? According to Pharmacy Guild:

A Clinical Intervention (CI) is a professional activity undertaken by a registered pharmacist directed towards improving quality use of medicines and resulting in a recommendation for a change in the patient’s medication therapy, means of administration or medication-taking behaviour.

Or, in general terms, solving drug-related problems (DRP). An example would be a drug duplication problem where a consumer is taking two different drugs, both containing paracetamol, at the same time. This is a DRP, and by solving this problem, the pharmacist is conducting a CI.

Here is the important part: by conducting CIs, under the 6CPA accredited pharmacies are able to claim money from the Government. The exact amount per CI is not known, where some said it is ranging from $1-5 dollars per CI.

Similar to MedsChecks, many pharmacies are setting CIs as a KPI target for staff where they have to submit a certain amount per day (3.5% of prescription volume) as a daily task.

Problems associated with CIs

Helping patients and earning extra cash to pocket? Sounds great, doesn’t it? But wait, here is a question: Isn’t solving clinical problems a core and regular duty of pharmacists?

PSA defines pharmacist duty as including the duty to “advise patients on how their medicines are to be taken or used in the safest and most effective way”.

So since when it is appropriate to claim extra money to do our daily tasks? Pharmacists should intervene and help patients with or without the financial rewarding scheme.

Pharmacists do not need a “tip” for doing our job properly.

Do doctors or nurses or other healthcare professionals submit clinical interventions after they help with patients? Not to mention that the money is going into the pharmacy owner’s pocket, not the actual pharmacist who did it.

Some might argue that if the pharmacy is making more money, they will (hopefully) give us a raise and reward their pharmacists.

First, CI has been around for six years, and have pharmacists pay improved at all? Not to mention again that this is your job, to solve clinical problems, and your salary should have included that already.

The whole CI scheme should not exist in the first place. Before this is established, do pharmacist NOT know how to solve problems and help patients?

On top of that, most CIs are NOT being conducted in a professional manner. 

Unqualified submissions are being sent every day, and there are no mechanisms or intentions to prevent it.

Despite the fact that the 6CPA clearly states that routine prescription-related counselling and CMI provision are NOT CI, a lot of claims are simply nothing but companion selling: recommend probiotics for antibiotics prescription, recommend sunscreens for drugs with Label 8, etc.

Audit reviews also show and criticise that some pharmacists are claiming CI by sending a HealthNote text to remind them the script is ready. Those are “interventions” that retail pharmacists today have to do in order to reach the quota.

How would the public think of pharmacists if they know their taxpayers’ money are being spent this way?

I am aware of that retail pharmacy is in a desperate and dreadful situation where a lot of us are struggling to survive. However providing a high standard of healthcare services is a pharmacist task and financial incentives are not required, especially when the system is being abused.

Do you think pharmacists are feeling satisfied and accomplished after being forced to submit those claims? I think CI is not clinically relevant and should be removed (not that it is going to happen soon).

I am not saying the Government should allocate less resources to pharmacy, however taxpayers’ money should and can be used in a better way.

What distinguishes a good pharmacist from an average one is that a good pharmacist CARES for patient health instead of chasing KPIs like CI or selling CAMs.

Please share your stories or experiences with Clinical Interventions.

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17 Comments

  1. Graeme Holloway
    26/07/2017

    Surely the fact of the matter is that these things take time and in the past it was done for no extra return and now there is payment. Of course also any rorting should be stopped.

    • H Shan
      26/07/2017

      I think these are the job components of a community pharmacist. If not, then anybody able to run a dispensing software and put label on the box should be able to work as a pharmacist.

      Imagine doctors are charging separately for checking your BP, taking body temperature, and examining your mouth/tongue etc.

      No wonder some doctors believe pharmacists are just packer of the medicine.

      • Usman Hameed
        26/07/2017

        Hmmm actually doctors do get paid for different stuff. Please check the MBS

      • Karalyn Huxhagen
        27/07/2017

        I work within a GP superclinic and tge GPs do charge very high fees for all extras e.g dressings, reading printouts patients bring in from Dr. Google. Signing certificates ir release forms. The entrepenereul GP super groups worked out a schedule for basics and extras a long time ago. Patient pays for most of the extras not govt.

  2. Hany Aita
    26/07/2017

    I think the main problem is that the line between professionalism and financial profits has been crossed a long time ago. This is really the origin of all evil in our profession now. In the past, community pharmacy was very profitable that owners didn’t really need to cut corners to make money. Now with all the pressure of PBS cuts and discounting models prospering, it’s putting financial pressure on all owners. Now all owners are trying to squeeze money from every corner. This includes cutting staff hours and so less customer services, focusing on recording CIs and Medschecks and stocking anything that sells regardless of its relation to pharmacy.

    Now pharmacies stock homeopathic and complementary stuff that has no evidence more than ever as long as it sells. We now stock sex toys. Owners are pushing their pharmacists to record whatever CIs and Medschecks regardless of how they do it in addition of course to companion sales. I remember I used to work for an owner in a pharmacy group who used to call Medschecks “Money for jam”. Many owners are now developing targets to achieve that involves companion sales, CIs and Medschecks and of course performance is assessed against achieving these targets.

    The community pharmacy has to evolve. Government remuneration has to be for services rather than product supply. This is the only way we will avoid all of these unprofessional acts that are sadly common and destroying our profession. And unless the dinosaurs who are running the guild realise that, our profession might extinct in the near future

    • Consultant Pharmacist
      26/07/2017

      The recent evil is that $600 million that was earmarked for evidence based services has just been diverted to medicines supply CIs and Medschecks. This is enough to pay for 40 times the current HMR budget and could have funded many valuable applications for trial funding for ongoing services that were “neglected” by the Guild and DOH.

      This was simply a grubby deal between the Department and the Guild to improve the Coalitions re-election prospects by avoiding a bloody public stoush over 6CPA compensation.

      None of the Professions bodies have had the intestinal fortitude to make a stand on this issue.

      This is misuse of Public money on a massive scale and to put it in perspective could have paid for a Tesla battery in every state of Australia.

      Not happy Jan

      • Anthony Tassone
        26/07/2017

        Consultant Pharmacist

        As previously corresponded with you on other social media platforms, I would like to direct you to the landmark budget compact between the Pharmacy Guild and the Federal Government (particularly the section ‘Improved 6CPA community pharmacy programs’

        http://www.health.gov.au/internet/main/publishing.nsf/Content/141E774D384DD114CA25811B002759ED/$File/Agreement%20Guild.pdf

        The landmark compact will ensure that the $600 million that was initially held in a contingency reserve will be fully expended during the 6CPA period. It will also ensure that the pharmacy programs will also be redesigned to support the collection of information to
        allow assessment of the effectiveness of these interventions,

        The cost effectiveness assessment is important and required to gain future funding, as set out in Clause 6.1.3 of the Sixth Community Pharmacy agreement;

        “6.1.3 The Community Pharmacy Programmes set out in Appendix B will continue from 1 July 2015 until the Minister determines otherwise and will be subject to a cost effectiveness assessment by an independent health technology assessment body (such as the Medical Services Advisory Committee or the PBAC) as determined by the Minister.”

        Also with regards to funding for community pharmacy programmes, it’s important to refer back to Clause 6.1.2 of the 6CPA:

        The full 6CPA document can be accessed via:

        https://www.guild.org.au/__data/assets/pdf_file/0007/6100/6cpa-final-24-may-201558b59133c06d6d6b9691ff000026bd16.pdf

        The $600 million was not intended to fund applications for trial funding (rather the outcomes of these trials if proven effective), that is for the $50 million allocation for Pharmacy Trial Programs – Clause 6.1.2(b).

        The allocation for funds pharmacy trial programs is still in place with announcements of further tranches to occur in the future.

        Anthony Tassone
        President, Pharmacy Guild of Australia (Victoria Branch)

        • Consultant Pharmacist
          26/07/2017

          look let’s keep this simple Anthony.

          HMRs were an existing program conducted through Community Pharmacy so fit the intended Programs outlined for expanded funding.

          In the Guild- Goverment agreed funding in the 2017 Budget a particular group of people have been treated unfavourably contrary to available evidence of the worthiness of these services ie Accredited Pharmacists.

          This dececision is clearly in contravention to Federal Antidiscrimination Law.

          Please overturn this decision before Accredited Pharmacists are forced to take legal action against the Guild.

    • Andy Harris
      26/07/2017

      I think many pharmacies are still hugely profitable considering they are meant to be “small businesses”. The isssue is either the owners paid too much for the business or they just want to keep making more and more money regardless of how big or small there profits currently are. The argument that pharmacies are not profitable does not stack up when you are actually looking at the numbers and are trying to purchase!

      • Jarrod McMaugh
        27/07/2017

        Profitability of a pharmacy is very much a balancing act. The turnover could be awesome, but the overheads monstrous. Alternatively you could be doing great business on paper, but cashflow could choke your business to death.

        From my experience, a new owner needs to be able to assess inefficiencies and seal them off quickly, since you’ll likely be in a more leveraged position than the previous owner (ie they don’t have as much finance as you will have). I readily admit that this is very challenging, but essential for ongoing success.

        I bring this up because as a true small business, pharmacies don’t have the depth of funding to carry losses for a long period of time. It’s also unlikely that most pharmacies are making massive profits month on month without reinvesting money back in to the business…. Growth is created through investment & continuous reaping of profits isn’t a very successful model for any small business, especially in a market as competitive as ours.

  3. Reza Safaei-Hosseinpour
    26/07/2017

    I’m not sure why the example of Probiotics is used. This in my opinion is a clinical intervention (U3 of the classification codes PSA) not a general counselling point since it is a preventative therapy for the prevention of an adverse event. There is evidence both for & against use of probiotics for the prevention of AAD (antibiotic associated diarrhoea) & less evidence for prevention of other antibiotic associated conditions such as vaginal thrush. Hence, if a pharmacists’ clinical opinion is that a probiotic is clinical indicated/appropriate/may be benficial as a preventative measure than in my opinion it is a clinical intervention & I do claim for this if the patient chooses to take up my recommendation. Pharmacists are health professionals and are entitled to a clinical opinion as are other health professionals.

    • Andy Harris
      26/07/2017

      We just had a child represent to hospital with a distressed mother who didn’t fill the repeat for her antibiotics because she could not afford the probiotics which the pharmacist told her she needed and put
      A Helpful sticker on the box telling her she needed it. Do you really think selling someone probiotics is a genuine clinical intervention? Which adverse events are you preventing? Is there a lot of good evidence of cost benefit to this? Would you be proud to stand up in front of people and say “yeah I sold probiotics and got paid then claimed a clinical intervention from the government for it”?
      Is this really the clinical skills we want to demonstrate to the government if they ever actually look at the crap pharmacists are claiming?
      I can say from my experience that most “clinical interventions” are claimed automatically and patients
      are never even spoken to regarding the intervention or medscreen. I dare say most interventions are completely fabricated and not even linked to a real persons name! A lot of pharmacies are just using vague descriptions such as “female 21-65” no name required.

      • Reza Safaei-Hosseinpour
        29/07/2017

        Kindly look at the program specific rules July 2015 (draft) & July 2017. They state patient name is not required.

        Did I say they must have probiotics? Did I say that I place notes on antibiotic labels of the kind you have noted. Kindly read my comment in which I have also provided the indication. I noted that I provide it to them if they wish to accept my recommendation.

        As I said in my comment there is evidence both for and against the recommendation. I have my clinical opinion & am entitled to that opinion. I never have once suggested that a patient not take their antibiotic if they’re unwilling to take a probiotic in conjunction.

        If you wish to throw the kinds of accusations (indirectly) you’ve mentioned above about other pharmacists at me that’s fine.

        If you ever require me to stand in front of people and defend myself I am more than happy to do so. You have my full practicing name.

    • Andy Harris
      26/07/2017

      Oh also when is a probiotic indicated and when is it not indicated or is it just a blanket indication because they are awesome?

      Which strains do you recommend depending upon indication? Or is it just the one on special or the biggest mark up for the business?

      I just think these should be genuine interventions where we demonstrate our skills and value to the system not selling things which may or may. Or have value and will do nothing to lift our reputations should the wider community discover this behaviour

  4. Jarrod McMaugh
    27/07/2017

    I find this opinion piece incongruous…. And while I don’t want to deny another individuals opinions or the right to express them, I think that the majority of people will not agree with this piece.

    I have commented recently in the forum on CIs and why we need to be paid for them. I’ll quote the points from there here…. The discussion was about whether KPIs on professional services are appropriate.

    For KPIs, it depends on the culture of the organisation. I have soft KPIs – that is, they are truly indicators (the “I” part of the acronym) not targets. It’s a way of getting analytics on how effective we are being in providing our professional service.

    In reality, there are far more people who need the service than we could actually address, so having a KPI in place to measure how successfully we are meeting the needs of the community we service is important…. but it’s not appropriate for it to be a tool to create the need.

    My opinion on KPIs is a little different for CIs, because we are performing CIs every single day…. but recording them poorly. For most 9-5 shifts, I think it would be impossible for a pharmacist not to perform at least one intervention per hour…… the issue is recording them (which is the actual KPI I use for this item). I am strongly of the opinion that we need to record what we do (for clinical reasons if no other) and CIs with KPIs is one way to encourage practice change.

    I don’t think anyone could argue that we should take be recording every interaction that we perform. I think that the majority of people would also appreciate that every role that we do should be remunerated…. And these two things go hand in hand…. Practice change is driven by remuneration and recognition. The important thing is to aim for the practice of the best pharmacists, while auditing the process and payments based on the kind of practices that can ruin it for everyone.

  5. geoffrey colledge
    10/09/2018

    Many pharmacy groups and other “business advisors ” are recommending that a target number of CI’s be reached each day. This is unrealistic because it is leading to fake or at least questionable CI’s being claimed
    eg I read another pharmacist ‘s interventions and one was
    ” patient taking Panadol Osteo 2 twice a day and the intervention was to increase to recommended regime of 2 three times a day.
    If the patient was comfortable with twice daily, I don’t think this is a sensible intervention.
    There were many like this just so the target number could be reached to satisfy the area manager who is not even a pharmacist and had never worked in retail pharmacy

    • Jarrod McMaugh
      10/09/2018

      The example you give is an example of poor recording more than an unnecessary intervention.

      It could be as you say, that the person was happy with their treatment. OR, it could be that the person was experiencing more pain, and the pharmacist addressed this, but then didn’t state in their CI the reason for their advice.

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