Pharmacists — New Agents of Change for Improved Healthcare Delivery?

pharmacist and customerIt is becoming increasingly common to encounter new outlets for healthcare delivery within retail pharmacies, big box stores, supermarkets, etc. This phenomenon is not occurring by happenstance. We often hear there is a growing shortage of physicians, nurses and other healthcare professionals. Now, this shortage is likely to be magnified by the large number of newly insured patients entering the market as a result of the Affordable Care Act. These patients will need new places to seek care and new types of healthcare professionals to care for them.

One site of care that is becoming an increasingly attractive destination for patients is the retail clinic, due to the convenience and quality of service for basic healthcare needs. When we examine the average cost of a minor illness visit across different sites of care, we see that retail clinics provide a viable and cost-effective alternative:

  • Retail clinic: $76
  • Physician visit: $120
  • Urgent care: $121
  • Emergency room: $499

Given the reduced burden on the system, we can expect that healthcare delivery will continue to migrate outside of traditional physician and hospital channels, to non-traditional, lower-cost venues like retail clinics. In fact, the number of retail clinics is estimated to grow 25% to 30% annually to almost 2,900 by 2015. But who is primarily responsible for providing care in these locations?

Most often it is pharmacists who play a very active role in delivering care. They have expanded their role beyond drug dispensing to include medication reviews, providing education materials, administering vaccinations, and more.  Furthermore, they are well-positioned to continue to expand their influence on patient care.

As marketers, we should closely examine the potential role pharmacy could play to improve the quality and cost efficiency of healthcare delivery. As one of the key patient-facing allied healthcare professionals, they should be supported with education and tools that go far beyond their traditional focus on drug dosing and dispensing. Pharmacists have training and access to data that uniquely position them to help improve the patient’s journey from the first prescription after diagnosis, through ongoing adherent treatment, to chronic disease management and/or recovery.

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In the Ring

in the ringThere is a Spanish expression that goes: It is not the same to speak of bulls as it is to be in the bull ring. I’ve always liked it, because it seems to capture quite fundamentally the difference between being a spectator and a participant, an observer and an actor. I have paid my money and taken my seat at any number of events, sporting and otherwise; the few times I’ve been the one in the ring, literally or metaphorically, it was a considerably greater investment of self at that moment, and it occupied a lot more of my attention.

Often, I believe that the truth in this phrase applies to our line of work, medical communications, most clearly in the case of patients. We can argue or opine or assume what is best for someone facing difficult medical decisions, based on what we know and see, but until we are facing the same or similar situations and choices, it’s all just theory. Debating a hip replacement, or putting a child on therapy for ADHD? It’s easy to have an opinion, but much harder to know that it’s your choice to make, and your consequences to live with if you choose wrong.

This is why fellow patients are such critical sources of information for patient-centered decision making; it is the value of “experience by proxy,” of hearing from someone who faced the same challenges and choices that you did, and who is now living with those choices, that makes YouTube one of the most important channels for health information.

But what of the healthcare professional? Are they not, too, bullfighters in their own right, making decisions that deal with death and life, in big ways and small, every single day? I find myself in too many meetings in which we deliberate over the patient journey and decline to do the same for the physician, reducing them to a sentence or two, a professional epigraph and no more: “Neurologists like puzzles; psychiatrists don’t like touching patients; oncologists are like chefs.” These basic insights are helpful, up to a point, but I don’t believe that they capture what it’s really like to diagnose a patient with Alzheimer’s disease, bipolar disorder, or prostate cancer, not once, but many times a month, a week, or even a day. I’ve never done it, but as a field researcher have been an observer to many intricate, challenging moments that take place in hospitals and offices, and more than once, as a translator, have been asked directly, “What would you do?” The answer is never easy, and with the fourth wall down, you find yourself wondering if you are capable of making the right call.

It is these moments that most stick with me, as bringing home the gravity of the daily work of healthcare professionals. And I often try to remind myself of these feelings when discussing how best to reach a professional audience, to help them or to change the way they see a specific disease, or treatment, or test. We can make recommendations, but they have to live with the consequences of success or failure if they follow them. If we want to communicate effectively with our professional audiences, it is worth remembering that they face bulls every day; mostly, we just talk about them.

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Pharmaceutical Medicine: Moving From Molecule to Market

moleculeThe emerging discipline of pharmaceutical medicine trains a wide-angle lens on the process of drug development. It integrates the science, regulatory requirements, clinical development, commercialization and business affairs, drug safety surveillance and reporting under one umbrella. By definition, it is the discipline that considers drug development from molecule to market.

After 15 years in the pharmaceutical advertising/medical communications industry, during the past 2 years, I had the opportunity to pursue a graduate degree in Pharmaceutical Medicine accredited by Hibernia College of Dublin, Ireland. Uniquely, this program is the result of collaboration between the European Community and the European Federation of Pharmaceutical Industries and Associations, which includes many pharmaceutical industry partners.  My peers were professionals from Medical Affairs, Regulatory Affairs, Sales, and other departments in pharmaceutical company sites around the world, and the professors included company veterans from several relevant disciplines. Coursework covered regulatory requirements and pathways in all major jurisdictions worldwide and course content included modules such as Discovery and Formulation of New Medicines, Regulatory Affairs, Clinical Trials, Knowledge Management & Statistics, Health Economics, and Pharmacovigilance.

The relevance of this training to our industry is shown clearly by examples of the trends in drug development and regulation that are examined and form an integral part of the course.

For example, were you aware of the existence of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH)? This partnership between the regulatory authorities and the pharmaceutical industry of Europe, Japan, and the United States, initiated in 1990, seeks to foster greater harmonization of the scientific and technical aspects of drug registration to ensure that safe, effective and high-quality medicines are developed and registered in a manner that makes the most efficient use of resources (eg, minimizing the use of research animals and avoiding unnecessary duplication of clinical trials). The international Medical Device Regulators Forum seeks to perform the same role of regulatory harmonization in the medical device sphere. With economic globalization and the consolidation of the pharmaceutical industry and allied services internationally, it is necessary for us and our pharmaceutical industry partners to factor these initiatives into strategic planning.

In another development, and seemingly without much fanfare, in September 2013, the European Commission announced approval of Inflectra™ (Infliximab), Europe’s first biosimilar monoclonal antibody for the treatment of inflammatory conditions. Inflectra™ is a biosimilar to Remicade®—a drug with US$2 billion European sales in 2012— and is the first monoclonal antibody to be approved through the European Medicines Agency (EMA) biosimilars regulatory pathway. The FDA is in the process of elaborating regulations for the approval of biosimilars in the United States under the Patient Protection and Affordable Care Act.  The emerging global biosimilars market will be an important area of strategic interest for many of our pharmaceutical industry partners.

Knowledge of and an ability to evaluate and navigate the evolving healthcare space is the concern of pharmaceutical medicine and the business of our industry.

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Google Glass in Healthcare: Do We Really Want In-Your-Face Medicine?

Jamie Singer thumbnailYou look at Google Glass and you think The Times April Fool’s joke. You think of those pie-in-the-sky inventions wheeled out on Tomorrow’s World in the 1980s by Judith Hann (you know, the one with the perm who gave Kevin Keegan a run for his money).

Google Glass is Terminator vision. And it’s here. Now.  Like we don’t need any more distractions in our lives, Google Glass will project a tiny window of information onto the top right corner of our own, human visual display. Content is delivered as text, image, video or GPS-enabled alerts—something like this image here:


The technology, through its Star Trek-style visor design, will allow hands-free technology with POV (point of view) shooting—the sort of head-cam angles that we’re used to from a Lewis Hamilton Formula 1 helmet. Here’s a nice video showing what you might get up to with one of these devices sitting on your brow: http://goo.gl/QDGCE.

How has the technology world reacted? With moderate enthusiasm—the idea has been around for years and it’s clear the apparatus needs fine-tuning. Here’s a recent video review from The Guardian’s Charles Arthur: http://goo.gl/56OzE.

Charles makes the very valid point that a voice-activated device will make for a very chatty society and I personally don’t know how well this will work. Does anyone actually use Siri for its intended purpose? I’ve only ever heard people talk to Siri in look-how-cool-my-phone-is conversations (“I love you, Siri”… “I hope you don’t say that to those other mobile phones, Jamie”).

However, in medicine, there’s a bit of a buzz around Google Glass. Imagine you’re a doctor examining a patient. In the corner of your field of vision, you might have: patient vitals, treatment history, a list of current medications, related images (X-rays, scans etc.) and maybe differential diagnoses. This may well be triggered by facial recognition, but Google Glass is GPS-enabled, presumably allowing different patient data to ping up in front of your eyes as you walk around the hospital. Also, if the prediction is that technology will allow MRI scans (for example) to be superimposed over a patient’s body in real time, this could be hugely beneficial for diagnosis and management, with additional benefits in the training of new practitioners.

Here’s a 30-second German video showing the potential application of the technology: http://goo.gl/wfxXE

In another clip, Dr. Rafael Grossman demonstrates the use of Google Glass in an air ambulance emergency simulation, where I can imagine hands-free video conferencing could be life saving (though I can’t work out in this video why Dr. Grossman is wearing the expensive gadget and leaving his rescue team with an old-fashioned tablet to record the procedure). http://goo.gl/enfMM http://goo.gl/GpR4V

For patients, the technology could offer several health benefits. Hands-free diet and exercise applications could replace our smartphone apps—visual-recognition of our meals and an in-vision calorie-in/calorie-out counters could become the norm. In our industry, I wonder if adherence to medication might improve if patients had a little flashing pill in their field of vision every day.

However, no mention of Google Glass can be had without a discussion around privacy (since you won’t know if someone’s taking a picture of you). If this issue is resolved, presumably the same issues around confidentiality will arise that currently concern picture and video taking in the medical profession. I can’t really see how a wearable device will make much difference in this field.

Additionally, if recorded surgery and other procedures becomes the norm, clinicians may face the risk of scrutiny if things go wrong, both internally, and potentially from litigious patients. Although, I’m guessing this may well have a positive impact on procedural standards.

Ultimately, this is technology that could and should make healthcare services that little bit more efficient— with budgets getting tighter by the day, will this little gadget change the face of medicine and healthcare provision for the better?

Google Glass is due to go on sale to the general public in 2014.

Here are some links to some medical Google Glass blogs:

http://goo.gl/4rmMl http://goo.gl/ZGywr http://goo.gl/cMzUn http://goo.gl/Gstiw http://goo.gl/2qR6V http://goo.gl/PbgrU http://goo.gl/Wz3Y0 http://goo.gl/m8tNH http://goo.gl/frZlN

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