‘There’s professional ideals of pharmacy that have almost been abandoned.’

doctor and pharmacist armwrestle

A prominent GP and pharmacy critic has told the AJP that community pharmacy is losing its focus on its area of expertise, that Health Destination Pharmacy is like selling pharmacy’s soul and that commercial interests are taking precedence over community health.

The RACGP’s Dr Evan Ackermann tweeted to the Pharmacy Guild and Health Minister Sussan Ley earlier in the week that when only pharmacists are included in management of patients post-discharge, re-admissions increase.

He also penned an MJA InSight piece recently claiming that any Minor Ailments Service implemented by pharmacists would just be “a push by the pharmaceutical industry and pharmacy business to increase drug sales under the guise of health innovation”.

Dr Ackermann says that as pharmacy grows and changes it’s “interesting to see what pharmacy wants to grow into”.

“They’re entering areas that they have little expertise and training in, and entering areas in association with the pharmaceutical industry, and I’m concerned about that,” he says.

“Health Destination Pharmacy is in association with about eight different companies, and a couple are drug companies.

“They’ve set an unprecedented partnership between the PSA and industry, and that’s not really a professional development, that’s sort of selling the soul.

“I think at some point in time, pharmacy and pharmacists have got to look at their core responsibility in the health system and focus on that community medicines management, because those failings now are becoming more obvious. It just seems wrong as someone outside that sector looking in.”

He cites sector lobbying to retain codeine-containing over-the-counter medicines as one of these failings.

“Putting sales of drugs of dependency like codeine over safety, they have these STOP programs in they know it doesn’t work. They continue their association with complementary medicines and nothing’s done about that.

“It’s like there’s professional ideals of pharmacy that have almost been abandoned.

“I think a fundamental problem has been the Guild negotiating the Pharmacy Agreement for over 25 years; that’s led to the promotion of the business issues over the professional issues.

“I actually feel for the pharmacists – these are professionals trying to do their job, and they’re struggling, but the big business owners and corporates are raking in money trading on the pharmacist’s professional persona, yet the pharmacists themselves are being ripped off.”

On the subject of hospital readmissions, Dr Ackermann told the AJP that international evidence for pharmacist management post-discharge is not of high quality.

“Hospital pharmacies actually do a reasonable amount of work in this area and they have been particularly good at doing reconciliations, things like that, and there’s some evidence that it’s helping hospital readmissions,” he says.

“But in the community pharmacy, with HMRs and RMMRs and so on the capacity to reduce hospital readmissions has quite minimal evidence to support it and that relates to one study about heart failure.

“So you can’t say there’s no evidence but there’s a low quality study. Internationally multiple studies on this haven’t been favourable.

“The AMA did a submission to the Government about pharmacy in general practice and proposed a payment for this; they said it would be cost beneficial and had a DeLoitte study saying that but there’s not one bit of evidence to support that they can reduce medicines adverse events.”

Dr Ackermann told the AJP that these claims would need to be formally quantified.

“From a professional point of view I think the argument should be settled with a formal study, and that should be part of the pharmacy trial program under the Sixth Community Pharmacy Agreement. We need a formal trial to say, ‘okay, this trial is set up to see if a pharmacy review can reduce hospital readmissions as claimed’.

“And if it goes against the grain of international evidence and finds that it does, great. But if it doesn’t, we have information on which to base our health decisions.”

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