Unnecessary medicines sold to ‘unsuspecting customers,’ says GP

Doctors have again lashed out at suggestions that pharmacists could provide more health services, such as a minor ailments service

NewsGP reported on a recent study conducted by the University of Technology and the Western Sydney PHN, which looked at how pharmacists could help in common conditions such as colds, coughs, heartburn/reflux, headache (tension and migraine), menstrual pain or primary dysmenorrhea, and acute low back pain.

“The guiding principles were integration of community pharmacy practice into the health care system, collaboration with general medical practitioners and patients, high quality and safe use of nonprescription medicines and appropriate treatment of minor ailments,” the report says.

The researchers, led by chief investigator Sarah Dineen-Griffin, say that such a service is “ready to be rolled out,” and they hope to have it included in the Seventh Community Pharmacy Agreement.

The results included that pharmacists were 2.6 times more likely to change the customer selection of a medicine for self-treatment to a safer, more appropriate alternative; and patients were 1.5 times more likely to receive an appropriate referral by their pharmacist.

They were also five times more likely to adhere to that referral advice and seek medical practitioner care within an appropriate timeframe (20% of all patients were referred).

Pharmacists identified that 2% of all patients presenting to pharmacy had red flag clinical features requiring immediate referral to the GP or emergency department including shortness of breath, severe or disabling pain, fever and neck stiffness.

Pharmacists also provided self-care advice in almost all consultations (98%), compared to 62% of patients receiving usual pharmacist care. For example, patients presenting with heartburn were recommended to quit smoking by their pharmacist.

The report suggested a potential saving of up to $1.3 billion a year, thanks to alleviation of pressure on the health system.

But Associate Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC) has now told newsGP that pharmacies have an “inherent conflict of interest” because in order to remain economically viable, they must sell products.

“Who pays in the end? The patient does,” he said. 
“In the study the most common presentation was respiratory and 84% of patients were supplied at least one non-prescription medicine, mostly cough mixture or cold remedies.
“Pharmacy shelves are stocked with substances that are very low value. Supplements, homeopathy, children’s cough mixtures are generally unnecessary – but they are sold to unsuspecting customers.”

He said that interpreting the study “requires care” – and that consideration should be given to where this $1.3 billion could come from.

The study selected 15 pharmacies [24 patients each] to provide the minor ailments scheme and 15 pharmacies to provide usual care. It was not a study to compare pharmacy care to GP care,’ he said.
“What are the consequences?” he asked. “Will services to patients actually be reduced as a consequence of practices closing in marginal areas?
“Overseas experiences demonstrate that minor ailments schemes struggle even in countries where there is greatly reduced access to general practice; such as the UK, where there are far more patients per GP.
“The repeated history of schemes attempting to substitute general practice is that they look cheaper on first glance but end up being false economies.”

Former AMA president Dr Kerryn Phelps has spoken to The Australian, also criticising an expanded role for pharmacists.

“Pharmacies are not set up with appropriate privacy for consultations; there is also a perverse incentive for pharmacists to diagnose and prescribe because they will benefit from it,” she said.

“GPs might make it look easy, but it’s not,” Dr Phelps said.

The Australian also quoted Ross Tsuyuki, a pharmacology professor at the University of ­Alberta, who said that it was a “common misnomer” that pharmacists would prescribe more medicines.

Meanwhile in Queensland, Pharmacy Guild state branch president Trent Twomey reacted to an Australian Institute of Health and Welfare report which showed that more than 179,000 Queensland hospitalisations were potentially preventable in 2017/18.

Allowing pharmacists to work to full scope could help prevent these, he said.

“Alarmingly, over 20,000 potentially preventable hospitalisations due to urinary tract infections were recorded during this reporting period.

“The quickest way to take pressure off patients and hospitals, is to allow pharmacists to work to their full potential. For example, instead of having to wait for hours at an emergency department for antibiotics, that they may have had before, to treat a urinary tract infection– a patient could be prescribed medication by a pharmacist immediately.

“Excessive wait times and high costs of local GPs have long been a barrier when it comes to Queenslanders accessing health services.

“The report makes it clear there is the potential for pharmacists to make the most of their training, reduce costs on the public health system and play a larger role in making sure Queenslanders have the best possible health system,” he said.

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  1. pagophilus

    So benefiting because you sell a product is wrong, but benefiting because you get paid (by the patient and/or Medicare) for the patient just to talk to you is not?

    • Jarrod McMaugh

      This highlights a significant issue.

      The concept of Conflict of Interest is based around the need to acknowledge where a conflict may exist, recognising it, and ensuring that your practice/dealings/etc are performed in such as way that you don’t capitulate to that conflict of interest.

      So, yes there is a potential conflict of interest in earning an income from “selling” something. The question is, is there capitulation to this conflict of interest?

      That ‘something’ is not restricted to physical products. It very much includes services that are intangible.

      From the wonderful resource of wikipedia:

      The presence of a conflict of interest is independent of the occurrence of Inappropriateness. Therefore, a conflict of interest can be discovered and voluntarily defused before any corruption occurs. A conflict of interest exists if the circumstances are reasonably believed (on the basis of past experience and objective evidence) to create a risk that a decision may be unduly influenced by other, secondary interests, and not on whether a particular individual is actually influenced by a secondary interest.

      The thing that worries me when medical groups harp on this discussion is that there seems to be a genuine belief from some medical practitioners that they have no potential for a conflict of interest…. and this is alarming.

      If a person does not understand the potential for conflict of interest, how do they avoid capitulating to it?

      • pagophilus

        Doctors would have no potential for conflict of interest if our model for remuneration of doctors was capitation and they were paid whether they saw patients or not, but that’s not how our Australian model looks. One could argue that by forcing patients to come back to the GP for review rather than giving them max repeats the doctor is also working in his/her own interests. Or by asking you to come in and see them rather than giving you the test results over the phone.

        • Jarrod McMaugh

          capitation still has potential CoI.

          In that instance, *not* seeing the patient as often as they may need is one way it can occur.

          There is also the issue of maintaining the patients loyalty by giving them what they want (like antibiotics for viral illnesses)

    • Karalyn Huxhagen

      agree whole heartedly. Currently have a large bundle of HMR requests on my desk from a practice which has obviously completed a nurse led scan of their patient file. they have generated requests that the patients I call to make an appointment have no idea that it was generated on their behalf. The GP has then asked for a percentage of my payment fee to offset his nurse costs (which is illegal). Commercialization to pay the bills may differ in phcy to GP land but we are all selling a product

    • rose DJOUDI

      well said !!!! and most times I ask the patient do you know what the medication is for ?? a lot of times the answer would be : I don’t know the Doc gave me the script and said to take it !!!

  2. Bruce ANNABEL

    To remain viable community pharmacists need to ensure health consumers keep returning, just like doctors do. Today’s progressive pharmacists do this through helping solve health issues by referral to other health professionals such as GPs, giving advice even if a product isn’t part of the solution and when it is ensuring the right health solution recommendations are made.

  3. Karalyn Huxhagen

    my other comment to this scenario is that many of the Rxs we receive are for OTC products. Customers complain bitterly that they have paid $110.00 to see the GP to receive a product that they could have purchased from the pharmacist.as a pharmacist I do my best to explain that while they could have bought it direct from me if they came in and described a day of stomach cramps following a dose of food poisoning , they have had the GP assure them that they do not have a more serious ailment.There are so many minor ailments that we triage each and every day. we are trained what is our scope of practice and when to refer. Minor ailment schemes are very popular in many countries esp where there is a GP shortage. very busy and harried GPs appreciate our support. Both Kerryn and this Prof guy are way of line and obviously do not visit a pharmacy that practices professionally.

  4. Nicholas Logan

    Over the last decade I have met more GPs that supply homeopathy than pharmacists.

    • rose DJOUDI

      NICHOLAS and send the patient to us with a script for an OTC and when informed the patients are often unhappy and frustrated that they waited and paid for that

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