JUNE,Edition # 28, 2001

As I sit here in front on my word processor the thought comes to me "Am I a slow learner, or what?"
After some eight years working with our Veteran Community you would think that I would have had the two prime rules of defence forces drilled into me.
These are of course:
* "Never stick your head up or you'll get it blown off" and,
* "Never, never volunteer"

So, why do I raise this question?
I broke the first rule, of course, when I wrote a letter to the editor of this newsletter, placing me squarely in the sights of anyone who disagrees with my ideas. Then to compound my "error" I accepted an offer from Neil (the editor) to become a regular contributor. "Slow learner" obviously describes me.

Now, self flagellation aside, I would like to consider a story that appeared on our local radio news this morning. "Cost blow out threatens PBS" blared out, highlighting a 50% increase in PBS programme costs over the past five years. "Surprising" I thought "seeing that PBS expenditure had been rising by some 12-15% per year, a 50% increase is relatively conservative!"
Headlines such as this should strike fear into Australian pharmacists as no government can continue to accept cost rises of this magnitude. Something will have to give and pharmacy may find itself between a rock and a hard place.
I remember when I started my career in community pharmacy (in the middle to late 1960s) we operated on a 33% mark-up plus dispensing fee. This at least gave pharmacy an opportunity to expand it role while remaining viable and accounts for the profession's habit of offering so many free services.
As the margin was decreased to 20%, then 10% and below the buffer was lost but the expectation of free advice and counselling remained.

We now have the situation where pharmacists want (indeed are expected) to move into more pharmacy profession orientated activities but do not have the necessary resources.
What happens if the margin is reduced even further?
Cost pressures are going to increase the importance of quality use of medicines (QUM) programmes to government.
The Department of Veterans' Affairs (my employer) has for many years been involved in such QUM programmes, educating prescribers and Veteran patients on more appropriate use of drugs.
Although we were the first, other departments have taken up the programmes, signalling that government is serious about costs and opening a window of opportunity (don't you love that expression?) for pharmacy.
What profession is more qualified to advise and assist in getting value for money in relation to drugs?

It has been interesting to see the angst that has been caused in the medical profession by the advent of medication reviews by pharmacists, but we, as a group, are specialists and must be seen to be contributing.
Domiciliary Medication Management Reviews (DMMR) has been a hot topic in the past three (March-May) issues of "Australian Pharmacist", raising a number of issues I would like to explore in future articles. DMMR, however, is an avenue by which pharmacy can demonstrate its ability to give value for money in drug use and we should embrace the chance to "trot our stuff".
(Sorry, I'm having a bad day-I am not usually prone to talking in cliches.)
Please note that opinions expressed here are my own and not necessarily those of my Department.
Ends

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