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George’s Corner: November/December 2014

Xstal
Ball ––>
by George Pennebaker, Pharm.D. 

This
issue is all about what people think will happen next year. So
I got out my crystal (xstal) ball and exam
ined
it carefully.

Big
blur — foggy ball — too many unpredictable influences.

This
is written before the November mid-term elections. That is the
biggest unpredictable influence. Will we have another
unfruitful Congress, or will one side take over? (Or maybe, we
might get some people who are willing to talk to each other.)
Maybe there will continue to be so many other things to occupy
the front pages and the evening news that healthcare will
proceed on the paths set by previous years.

My
unreliable guess is that there will be so much other stuff
going on that we will continue down the paths that have
already been laid out.

So…

I
firmly believe that pharmacists will find themselves doing
more clinical stuff.

There
will be immunization program expansion, providing additional
vaccines and an increase in the number of doses of
immunizations now given. Settings to do this will be improved.
Other providers will reduce their grip on the service. The
public will embrace the ease, reliability, and availability of
pharmacist immunizations.

We
will see an increase in pharmacy-located clinic offices. There
will be lots of trying of different floor plans and financial
arrangements. It will take a few years for this turmoil to
settle into some kind of standard arrangement. I find the pet
store model rather interesting, regarding layout. There is a
veterinary office at the back of the store, alongside the dog
and cat grooming shop. I have no idea what the financial
arrangements are, but they may be interesting.

Pharmacists
will also be doing more of other clinical functions.
Prescribing will grow, first under protocols, then evolving
to independent prescribing. I expect (and hope) that this
will be in nonpharmacy settings.

In
this regard, it is interesting to note that the number of
physicians who are salaried employees has moved from about
14% to 42% in less than ten years. The private practice of
medicine is declining rapidly. Physicians are going to
places where they are not employers trying to meet a pay
roll,
instead becoming employees working inside larger
organizations that allow them to spend more time being
physicians.

Pharmacists
are doing the same thing. We are moving from small
independent
practices
to being part of larger organizations — lots of pros and
cons on that one. ‘Nuff said.

All
of those new pharmacy schools are starting to produce
graduates — looking for work. Those new schools have been
selling themselves based on current salaries and financial
aid programs. Over the 55 years that I have been watching
the ebb and flow, the ratio of available jobs to available
pharmacists has come in waves. This “too many pharmacists”
wave will recede, and the mediocre schools will fade away.

So-called
“specialty pharmacies” will increase until their financial
advantage gets neutralized by there being so many of them
that they have to compete on price instead of uniqueness.

What
about the products that are managed in the pharmacy setting?

In
the last couple of columns I have written about the new
health-oriented gadgets being developed by in
novative
technology people. I believe there is a role for pharmacists
in the understanding of these gadgets and their proper use.
We will be seeing a lot of them in the next year. What is
our role?

The
recent change in the scheduled drug lists (Vicodin is now a
Schedule II) is a reaction to a big problem. Pharmacists are
going to be instrumental in dealing with this problem. It is
not only narcotics that are being misused. Antibiotics,
psychoactive drugs, and others are also being misused. They
need a similar level of attention and innovative ideas about
how to deal with issues that arise.

I
will never forget a physician telling me that he just

about
always writes a prescription for the drug the

patient
asked for. If he doesn’t, a) it takes a long time

to
explain to the patient that it is not needed, and b)

he
loses the patient to another physician who will.

Pharmacists
will be given a greater responsibility for monitoring and
interceding in misuse situations, if only because the third
parties and other computer checks will identify them to the
pharmacist because the pharmacy transaction provides the
data. This, of course, increases the time it takes to
process a prescrip
tion.
Compensation becomes an issue. As long as compensation is
based on how many prescriptions are filled, proper care is
compromised. We have already seen this in the warning
notices that are constantly sent by computers. Hopefully,
some breakthroughs in this contradiction will be made in the
near future. Other
wise,
care will be compromised.

What
about the computers that we curse, but cannot
do
without? Again, breakthroughs are needed to make them easier
to use, as well as providing additional information.
Computer systems engineers need to spend more time in
pharmacies observing, taking notes, listening,
and being creative. I hope we see more of that in the near
future. They need to see the lines of people (and their
screaming children) trying to get through the final steps in
their day’s medical stresses.

I
am still an optimist. I believe these issues can be
resolved.*

*Long
ago I had a boss who hated the word “resolved.”

He
said it was only good for New Year’s resolutions.

Otherwise,
it meant solved again. That meant that

it
was not solved the first time. Perhaps re-solving is

needed
for many of the issues we face.

Best
wishes for 2015. May your issues be solved. May you prosper,
even with the new challenges that face our profession.
CT

George
Pennebaker, Pharm.D.
,
is a consultant and past president of the California
Pharmacists Association. The author can be reached at
george.pennebaker@sbcglobal.net; 916/501
6541;
and PO Box 25, Esparto, CA 95627
.