Money for Nothing
No, not the Dire Straits song, the strange request for extra government funding by the pharmacists for extra services to clients.
“Pharmacy Guild chief executive Annabel Young said pharmacists wanted to be given the right to help patients in managing chronic conditions such as diabetes, heart disease and asthma through health counselling and guidance on prescribed medicine use. They also wanted to be able to carry out medicine-use reviews, which involve monitoring patients’ use of prescribed medication to ensure better results and cut the costs of unused medication.
“Other services included nicotine replacement programmes and providing the emergency contraceptive pill.”
They all sound like helpful services and Tony Ryall seems keen on the idea.
The MacDoctor says “beware of Pharmacists requesting funding”
The Herald editorial urges caution on the part of the Minister and I heartily agree. Look at what the pharmacists are offering:
1. Management of chronic conditions
This is a thoroughly stupid idea. It is hard enough to get diabetics to get regularly checked at their doctors as it is, without providing a lesser service at the pharmacist which said diabetics will almost certainly perceive as an alternative to seeing the doctor. Will the pharmacist be taking responsibility for checking that diabetics are monitored for retinopathy (from which they can go blind), peripheral nerve damage (from which they can lose limbs) or Nephropathy (kidney damage)? Thought not.
What additional monitoring and advice can a pharmacist provide on asthma management that the GPs practise nurse cannot? Nothing. And don’t get me started on the pitfalls in trying to manage heart disease in a pharmacy. Words fail me.
And Ms. Young’s reason for the proposal:
“But Annabel Young said the proposal was not about taking patients off doctors but catering for people who could not get an appointment with a GP or could not afford one.”
Most of these monitoring programs are already funded by PHOs and are free, or nearly free. And the appointment story is just nonsense. We are talking about monitoring programs here, not acute problems. Even the busiest GP practice can provide an appointment with a day or two’s notice. A pharmacy monitoring program would be a duplication of current services and remove valuable funding from more useful areas of health (you didn’t think that Tony Ryall was going to provide extra funding for this, did you?)
2. Medication Reviews
Perhaps Ms. Young might wish to explain why this is not happening anyway. Or does she think that the pharmacist’s scripting fee is for taking the trouble to print out labels and stick them on the box of medicine? The entire reason why we have drugs only available by pharmacy is so that the pharmacist can monitor the provision of these drugs including checking for side effects, drug interactions and usage. Why Tony Ryall would want to provide extra funding so that pharmacists act like pharmacists is beyond me. And spare me the cutesy “home visiting” idea. That is a task much better accomplished by district nurses who can properly monitor a patient as well as check their drug usage.
And I should point out that most pharmacists of my acquaintance seem to be reviewing medication usage quite well without the extra money. Presumably, they think it is part of their normal job too.
3. Nicotine Replacement Programs
Terrific plan. I’m sure we really need to duplicate all the smoking cessation programs that are currently available.
Yes, that was sarcasm.
4. The emergency contraceptive pill
No real argument from me here. I don’t see a problem with pharmacists being able to provide this without prescription. I just don’t see the need for extra funding over and above Pharmac subsidising the drug and family planning providing pregnancy test kits (you did know that you should do a pregnancy test before prescribing the emergency contraceptive pill, didn’t you? )
So all in all, I see no benefit in the call for extra funds. Ms Young quote dubious statistics:
“Every 10 to 15 people who had a medicine use review worth about $200, stopped one hospital admission worth about $5000.”
I wonder who decided what the price of a medicine review was? Is $200 really appropriate for 30 minutes work (I should be so lucky to earn $400/hour)? And the price of the hospital admission is the average price of an admission, not the real, marginal cost of an adverse drug reaction, which is much less.
Like I said Tony, beware Pharmacists requesting funding.
P.S. You can use the same rule for doctors too!
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May 6 09 6:42 pm
You don’t oppose the morning after pill then?
I don’t either provided it is used to prevent conception rather than to prevent implantation I would support an accurate ovulation test/prediction being carried out. I do not support it being used if it will act abortifaciently.
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May 6 09 7:19 pm
Madeleine: The MAP is an abortifacient, in that it prevents implantation rather than conception. The reason why a pregnancy test should be done is to ensure that the woman is not already pregnant as the MAP is obviously not an appropriate treatment in this case.
Bear in mind that the majority of ova in a sexually active female are fertilised but only a few are successfully implanted. The MAP is just decreasing the odds of successful implantation in much the same way as the ordinary contraceptive pill (hence the standard Catholic objection to the pill).
My take on this is that contraception is proactive, decreasing your chance of becoming pregnant by varying degrees. Abortion, however, is retrospective, attempting to remove an established pregnancy. The first is simply improving your odds, the latter an attempt to adjust reality.
Regardless of the theological implications (which Matt would probably know more about) there is no doubt that women react emotionally in a far different way to contraception, than they do to abortion. It is therefore absurd to use the oft quoted argument that abortion is simply an extended form of contraception. They are two distinct issues.
Thus I am comfortable providing a MAP or a script for OCs but I will have nothing to do with requests for termination of pregnancy.
May 7 09 4:52 pm
My understanding was that the MAP is an overload of the hormones found in the combined pills that can act to both suppress ovulation and thin the endometrial layer. Thus taken at the beginning of the cycle it can prevent conception, however, if ovulation has already occured then all the MAP can do is thin the endometrial layer and make implantation difficult. Hence what I said – but I only know what I have read on the packets and instruction sheets these things come with and what medical journals I have been able to read on the matter, I am sure you would have far more expertise than I would.
I think the reason for many women’s acceptance of oral contraceptives and the others that work in a simalar way comes from a misconception that these work to prevent ovulation as indeed early versions of the pill did. This misconception is not helped by the medical profession’s use of the term “preventing pregnancy.” Now you and I know that this medical term refers to implantation but the average person thinks it means prevent conception.
I would think that most women would be at least uncomfortable if they thought they could potentially be passing a conceptus with their menstrual cycle each month – of course most women do not know this when they take their pill or get their jab.
As to theological concerns Matt, controversially, is agnostic on life beginning at conception as he argues in his stem cell article and resulting comments, but in that article he points out that agnosticism still requires us to err on the side of caution and not risk the potential of taking a life. Myself, as a non-catholic who whole-heartedly supports safe contra-ceptives (literal meaning: prevention of conception) I oppose birth-control or those means that permit conception but prevent implantation.
Good on you for your stand on termination requests. I know that it is very tough to be a doctor who refuses.
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May 8 09 10:53 pm
Some very good points in the post. I’d see a pharmacists role in health care as falling more into health education and some assessment of minor health conditions (like if you turned up there with a problem with acid stomach) where they can tell you what OTC stuff is available or tell you to see a doctor if it seems suspicious for any reason, it probably helps avert a lot of unnecessary visits to doctors for minor ailments. Recommendations to take this further is at a minimum duplication but with a lesser level of health care than going to the doctor who is able to assess, diagnose and treat a whole range of health issues. As for the rest, I’d say most people wouldn’t realise that medication reviews and such should already be being done and the rest are simply reinventing the wheel so to speak.
“I would think that most women would be at least uncomfortable if they thought they could potentially be passing a conceptus with their menstrual cycle each month”
Ummm, not necessarily. One distinctly comfortable person here, because the whole point of using contraception in the first place is not to get pregnant and have a child. I don’t particularly care if that might happen if it achieves this end because at that stage you don’t have a established pregnancy but it’s simply that an egg *may* have fertilised. If it was an established pregnancy I’d see it as something very different as there is a baby in there but it’s not the case in this situation. I’ve had my much wanted and loved children and simply do not want (and cannot afford) to have any more even though I vaguely knew that some contraception had this effect prior to using a permanent form of contraception – vasectomy. Presumably this is acceptable as a form of contraception while the other is not, even though it’s pretty much irreversible and the other forms of contraception at least allow for a woman to conceive once they are ceased.