How much do you do for free?

hand out for money - coins in palm

Pharmacists in this new study say unremunerated services account for 15%–50% of their daily activities, with competition from discount pharmacies putting these at risk

Pharmacists report delivering unfunded services daily for which no remuneration is being provided to the pharmacy, according to researchers from the University of Otago, New Zealand.

In their study, 24 community pharmacists participated in six focus groups, sharing their thoughts on which services they provided and how they were funded.

The majority of participants were full-time employee pharmacists, although the sample included pharmacists from a range of different practice settings, years of practice experience and genders.

Time spent delivering services for no remuneration across participants was estimated to be between 15% and 50% of daily activities.

Medicines-related phone queries from patients and health providers were described as contributing to a substantial amount of pharmacists’ daily activities, with no result in remuneration.

“These queries included patients enquiring about medication dosing, the use of medicines purchased from the supermarket or another pharmacy, and medicine dosing information for children,” said the authors in Research in Social and Administrative Pharmacy.

“Phone enquiries from doctors were also common where queries often related to patients who were not known to the pharmacy.”

Another unfunded area was patients requesting advice and recommendations for medicines to treat common and minor ailments.

Pharmacists stated that advice on such conditions usually achieved one of three outcomes: either sale of an OTC medicine; no sale as no product required; or triage through referral to a GP or other healthcare provider.

“In this scenario the pharmacist is only partially funded if the clinical consultation is followed up with the sale of a product,” said the researchers.

Participants noted that there is no minor ailments scheme in New Zealand, just as there is none in Australia.

“One of the big parts of our job is minor ailments and it’s an unfunded service. It would make the most sense for minor ailments to be dealt with in a pharmacy and attract funding,” said one participant, mid-career pharmacist in an urban chain pharmacy.

Recent research in Australia has examined how community pharmacists can help with several minor ailments, with leaders calling for the establishment of a funding model that reflects the time, quality and complexity of community pharmacist care.

Meanwhile New Zealand study participants added that they were frequently asked for advice about supplements and other natural health products, particularly regarding efficacy and potential interactions.

They noted that enquiries relating to these products consumed a larger amount of time compared to an equivalent consultation on a therapeutic product.

The authors said pharmacist participants felt strongly that additional services being offered in pharmacies are funded by a ‘compassionate budget’, and in instances where the patient pays a fee for the service, it is largely a token gesture given that it is often below the cost of service delivery.

“In New Zealand, the lack of remuneration for the provision of such services, and the current reliance on cross subsidisation to achieve financial viability for service provision, may put the services at risk of being lost, particularly as revenue diminishes due to competition from internet sales and discount pharmacies,” they said.

The findings are easily comparable with the Australian pharmacy landscape.

Poll results from AJP in 2018 found that across 250 Australian pharmacists, 60% of respondents provided a large proportion of services for free in their pharmacies.

These services ranged from health advice to screening tests, such as blood pressure measurement and blood glucose testing, mental health support and free deliveries.

“Findings from this study can be applied to unfunded pharmacy services elsewhere, as worldwide pharmacy faces many similar challenges, particularly where there are budget cuts and decreasing revenue in other jurisdictions,” the authors conclude.

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