Replacing pharmacists with robots isn’t the answer to better productivity

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Pharmacists aren’t just dispensing machines.
from http://www.shutterstock.com

Helen Dickinson, UNSW

Reforming pharmacy services and the role of pharmacists is one of the recommendations made in a five-year review of the nation’s productivity, released yesterday. The Productivity Commission’s report, Shifting the Dial, highlights community-based pharmacy as a “significant unnecessary cost to the nation” and asks whether automated dispensing machines could replace pharmacists.

In recent years, community pharmacy profit margins have eroded as warehouse-style pharmacies offer lower prices and supermarkets and other retailers sell more non-scheduled medicines and complementary medicines. Some smaller pharmacy operators have questioned their viability and report feeling under threat. A number of pharmacists have already left the industry in anticipation of further pressures.


Read more: Discount chemists are cheapening the quality of pharmacy along with the price


The Shifting the Dial report argues pharmacists are constrained in offering quality health outcomes:

the availability of unproven and sometimes harmful medical products and confectionery at the front of the pharmacy is not reconcilable with an evidence-based clinical function at the back.

The Productivity Commission’s answer is automatic dispensing machines, supervised by a “suitably qualified person”. Along with the machines, pharmacists would play a “new remunerated collaborative role with other primary health professionals” where cost-effective.

These changes would mean there would be less need for the current 20,000 pharmacists around the country.

Automated dispensing

The idea of using robots to dispense drugs is not a new one, either in Australia or internationally. Automated dispensing devices have been used widely in hospitals around the world since the mid-1990s as a way of reducing medication errors, improving patient safety and decreasing costs. Over the last decade these devices have expanded into community pharmacy settings as financial pressures have driven the search for efficiencies.

Automated systems can reduce the error rate in dispensing medicines, but they also introduce different types of errors into the system too. Entering prescription details wrongly or not loading the machine correctly can have significant impacts.

Automated systems are expensive to buy so may not be cheaper over the short term, particularly when we consider the average wage for pharmacists is relatively modest. A recent government report notes:

[in] Australia, pharmacy graduates had the lowest starting salary of all industries requiring higher education training.

Given the investments required to buy automated machines it may be that not all local pharmacies have these. We may see the emergence of a hub and spoke model. This involves prescriptions coming into pharmacies, being sent electronically to a centralised dispensing hub and then returned to the pharmacy to dispense. This can be done either in person or via courier delivery.

This type of model is argued to be cheaper than the conventional system as it requires fewer pharmacists to run overall.


Read more: Robots in health care could lead to a doctorless hospital


In the UK there’s been pressure for community pharmacies to increasingly embrace automation for some time now. It’s well known their National Health Service has significant budgetary challenges and is looking for ways to save money. Plans to cut costs in pharmacy alongside commercial pressures from large chain providers, supermarkets and online prescription providers are predicted to cause the closure of up to a quarter of pharmacies.

This has, unsurprisingly, been met by significant resistance from the pharmacy profession as it challenges the existence of some jobs and will mean a move for others. But there’s good reason for others to be worried about these changes in terms of the impact on the broader health system.

Pharmacists can also offer advice on managing chronic conditions.
from http://www.shutterstock.com

The importance of pharmacists to the health system

Community pharmacists provide a number of functions that go beyond simply dispensing medications. In recent years we’ve seen pharmacists move away from just being those who fill our prescriptions, to people with a large amount of clinical knowledge who can advise how to take medicines safely and how to manage chronic conditions.

As increasing numbers of people experience chronic illness and take multiple forms of medicines, advice on how to do this in a safe and manageable way is crucial. Pharmacists are also probably one of the more accessible parts of the health system. Many of us will have sought advice from a pharmacist about how to manage an injury or illness, or what to do with a sick child if we can’t access a GP.

We’re seeing increasing calls to embed pharmacists within primary care teams to help better manage chronic disease. With growing numbers of individuals living with chronic disease and taking medication, pharmacists can play an important role in educating and advising on medication management.

This could improve medication use for consumers and reduce errors for those with chronic disease. Making greater use of pharmacists could reduce demand for GPs and other more expensive health professionals. For over a decade, pharmacists in the UK have been able to complete additional training that allows them to prescribe medication, helping to address shortfalls in the GP workforce.

Although the Productivity Commission report envisages a new role for a smaller pharmacy workforce, there’s little detail on what this might look like. And it underestimates the role pharmacists play within the broader health system.

If the changes outlined in the commission’s report are realised you might have your prescriptions dispensed by a robot in the future. But, it’s unlikely this will make a huge impact on the overall efficiency of the health system, and we would lose some of our most accessible clinical professionals in the process.

Helen Dickinson, Associate Professor, Public Service Research Group, UNSW

This article was originally published on The Conversation. Read the original article.

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How is the NDIS faring so far?

Last night I went on the ABC Radio show Nightlife to discuss how the NDIS is faring so far, a few months after the national roll out started.  The show was hosted by Philip Clark and I was joined on the panel by Fiona May, CEO of ACT Disability, Aged and Carer Advocacy Service.  We discussed why the NDIS came about, what some of the impacts have been and what needs to happen in the future.  A number of callers joined us with their perspectives for the second half of the show.

If you missed it you can catch the show here.

Emergency material and financial aid project

Over the last few months myself and colleagues at the Public Service Research Group have been working with the ACT Government around their Emergency Material and Financial Aid (EMFA) program.  The ACT Government is considering the nature and effectiveness of its EMFA program and we undertook an evidence review into EMFA programs, highlighting key tensions and issues in relation to Emergency Relief.  In this review we set out an overview of the types of services that these programs comprise, the evidence base around their effectiveness and the types of challenges and issues that EMFA services encounter.

Earlier this year we used this evidence review to facilitate a discussion with a range of stakeholders in the ACT around the degree to which local patterns in EMFA services match those in the literature and what might be done to further develop existing EMFA services.  The ACT Government is now embarking on a co-design approach that will seek to draw on key stakeholder perspectives and best practice in terms of the evidence base.

You can find the full evidence review here.

Individual funding systems: what works?

I have written much on this blog of late regarding the National Disability Insurance Scheme and the various research projects I am involved with around this.  But Australia is not the only country to have adopted an individualised funding approach and there is significant evidence from other jurisdictions about these schemes.

I have recently written an article for Evidence Base – which is the journal of the Australia and New Zealand School of Government – summarising the evidence relating to individual funding schemes.

What the review finds is some significant issues in terms of the quality of the research evidence.  However, there are a number of factors that aid the implementation of these types of schemes.

The article can be found in full here and there is a short blog summarising the findings on the ANZSOG website (link here).