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Freedom of information

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When an overseas pharmacy journal published the results of the University of South Australia’s study Provision of medicines information in Australian community pharmacies in February, pharmacists prepared themselves for a barrage of criticism.

The study, which found that overall only six per cent of consumers receive CMI with their drugs, was the latest in a series of warnings that patients were failing to receive the leaflets, despite pharmacists being paid to dispense them.

At last year’s APP conference, the Parliamentary Secretary to the Minister for Health and Ageing Jan McLucas told pharmacists to lift their game, reminding them that CMI provision was not optional but a professional obligation and that dispensing fees included a 10-cent incentive payment for providing the information.

Then last September pharmacists were again told to improve their delivery of the information, this time by the Australian Pharmacy Council, who said it had received reports from consumers concerned that they had not been provided with a CMI.

So this latest research, while only recently published but conducted in 2005, had many in the profession anticipating a public flogging.

And that’s exactly what happened.

Consumer group Choice seized on the research, saying it was proof that pharmacists “routinely failed to live up to their claims of being caring professionals”, and demanded a role for itself at the negotiating table for the Fifth Community Pharmacy Agreement.

Advocacy organisation Cancer Voices NSW said the study was hard evidence of what health consumers had been fretting for years.

“These were not just fears, we knew from the reported experiences of our members, and also of family and friends, that people were just not being given CMI by pharmacists,” said chair of Cancer Voices NSW Sally Crossing.

“Pharmacists have failed consumers not only in their duty of care but we believe that the ability to dispense drugs contains a responsibility to provide written information for the health consumer to have on hand.

“Also public money has been paid through the pharmacy agreements for this service and it has not been fully provided — there are various words to describe that situation…,” Ms Crossing said.

The profession isn’t unaware of the issues surrounding CMI provision — there is currently a Fourth Community Pharmacy Agreement research project underway investigating the barriers and facilitators to effective CMI delivery.

But many within the profession, including both the Pharmacy Guild and the Pharmaceutical Society of Australia (PSA), were wary of placing too much importance on the South Australian study, saying that the data was “outdated” and it was likely that there had been significant changes since the research was conducted four years ago.

Guild president Kos Sclavos, while not denying that CMI has its problems, defended pharmacists, complaining that the profession was being sent mixed messages from Government, consumers and doctors.

“In my pharmacy we have letters from over 30 medical specialists saying, ‘If a script comes from me, don’t give the patient a CMI’. They view the CMI as a barrier to the patient taking that medication because it might spook them. I know that’s illegal but it’s a confusing message to send to pharmacists,” he said.

Added to that the paper usage required to print CMI was being criticised by politicians on environmental grounds, Mr Sclavos said, and the Government had not committed any money to advertising the service.

“The Guild is so frustrated. At the moment we are spending millions on this process and are the only group doing so. Last year we spent $400,000 advertising CMI. The National Prescribing Service (NPS) is getting exorbitant amounts of money to advertise various programs…if CMI is so crucial why don’t they have a national advertising program on it? That would create some pull from consumers — there’s got to be some push and pull. Patient behaviour will drive pharmacy behaviour.”

In terms of workflow, Mr Sclavos complained that not all manufacturers had supplied their CMIs in a format that would allow pharmacists to integrate them with their dispense systems.

“At the moment we only have electronic CMIs for 84 per cent of products so our first complaint is more should be done to coerce more manufacturers to supply them. Some manufacturers say to pharmacists ‘Get it from our website’. Now that’s just not practical for pharmacists and their busy workflow,” he said.

Mr Sclavos repeated the Guild’s desire for an audit process to provide pharmacists with a record of whether or not CMI had already been dispensed to a particular patient, but added that software vendors would need funding to implement such a tool.

Mr Sclavos also invited the Federal Government to make it a mandatory requirement for pharmacists to provide CMI to patients on every occasion.

“If this is so important then I believe it should be mandatory. If it isn’t, then please get off the back of my fellow pharmacists because I have never received a complaint that a consumer was denied a CMI leaflet,” he said.

Dr Agnes Vitry, co-author of the South Australian study, said forcing pharmacists to provide CMI would see the profession lose its credibility.

“If we are obliged to do that it would mean it’s such a failure of pharmacists. It would mean they have not understood that their primary role was acting as health professionals who have the best expertise in medicines information. If they don’t choose to be recognised as a partner in the health care of patients they are at risk of losing their recognition as a valid partner in the health care team…they are just shopkeepers,” she said.

“In that case I don’t see the point anymore to have such qualified health professionals in pharmacies. There is no way we need people who have been trained for five years.”

PSA vice-president Shane Jackson was also against the idea of making CMI provision mandatory, saying that it would be more beneficial to create an environment where pharmacists value CMI as a useful tool for patient counselling.

“One of the most cited reasons pharmacists don’t provide CMIs is they think that they scare patients. Let’s look at how CMIs are laid out so we can improve that. We all know they focus way too much on the side effects and don’t balance that with the benefits of the medication. If pharmacists saw these as useful they would use them more,” he said.

Dr Jackson also advocated increasing the channels through which consumers can access CMI, something Cancer Voices NSW has been demanding for the past few years.

“There has been some progress as a result of our advocacy in this area,” said Ms Crossing. “Some pharma companies have agreed to replace the info inserts into the packaging of their products, following our request. Novartis was the first cab off the rank, and we appreciate their being a good corporate citizen. Others have shown interest which we must follow up.

“The TGA has agreed to host all CMIs on their website by 1 July 2009. We will need to work out how health consumers can find their way to the TGA website and pharmacists could well help in this,” she said.

But Mr Sclavos said the TGA was simply “replicating systems”.

“A central repository is not the answer. If they think that’s the answer that just shows how out of touch groups are with pharmacy practice. If you don’t have integrated systems it doesn’t work,” he said.

Whatever happens, it is clear that the current situation cannot continue, said Dr Vitry.

“Currently consumers in Australia are receiving less information than in any other developed country. Over the last few years despite all these campaigns and incentives encouraging pharmacies to provide the advice it has not improved a lot,” she said. “If pharmacists can’t provide this kind of service it means a consumer organisation would be right to question what is the value added by pharmacists.”


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