More medicines w/out prescription - cut health bill

Mellio

Just reading this in the examiner and thought it was a good idea.

http://www.irishexaminer.com/breakingnews/ireland/more-medicines-without-prescription-would-cut-health-bill-say-pharmacists-572573.html


If more medicines were avaialble to people via the chemist wouldnt this help reduce the health bill by having less fees to pay to doctors for consultations.

It would also allow for a better selection of medice other than the high priced medicines the doctor always seems to prescribe without any thought of cost.


I know there should be no worry of cost on health for the individual but as Tesco would say every little helps.

What do people think should the state allow chemists provide more medicines without prescriptions, what are the pro's and cons of doing this?

partyatmygaff

This and prescribing power for pharmacists (A la the UK and some other countries) would do a great deal to save money for the state and patients.

There are far too many ridiculous inefficiencies in public health. One big example are hospital prescriptions for people with a medical card. Why should you have to go to your GP just to get them to transcribe it to the proper stationery?

Godge

The thing is what if you take the wrong medicine off the shelf? What if there are overdoses of medicines like codeine? The pharmacists are not doctors. Who gets sued? A great idea but in Ireland, the home of the compensation culture, there is a risk.

Mellio

partyatmygaff wrote: »

This and prescribing power for pharmacists (A la the UK and some other countries) would do a great deal to save money for the state and patients.

There are far too many ridiculous inefficiencies in public health. One big example are hospital prescriptions for people with a medical card. Why should you have to go to your GP just to get them to transcribe it to the proper stationery?

Totally agree I dont think the GP is required in every instance to prescribe a medicine and think pharmacists are if not better equiped as they would be more up to date with modern and cheaper generic medicines than the dcotor normally prescribes.

twice in the last year I have been prescribed similar medicines when the pharmacist has advised that I go for a cheaper generic brand, surely a pharmacist is qualified enough so he/she can supply you with the right type of medicine required without the need for prescription.

creedp

Godge wrote: »

The thing is what if you take the wrong medicine off the shelf? What if there are overdoses of medicines like codeine? The pharmacists are not doctors. Who gets sued? A great idea but in Ireland, the home of the compensation culture, there is a risk.

I have to laugh when I hear the HSE ads pleading with people not to take antibiotics when they simply have a cold. Who actually prescribes antibiotics in this country? The idea that GP's actually reduce the amount of medicines consumed is a little simplisitc in my view

Mellio

Godge wrote: »

The thing is what if you take the wrong medicine off the shelf? What if there are overdoses of medicines like codeine? The pharmacists are not doctors. Who gets sued? A great idea but in Ireland, the home of the compensation culture, there is a risk.

This is the area of diagnosis and your right.

who is going to take on that responsibility of diagnosing you?

I think the pharmasist should have the rights to be able to do this, Im sure there is a lot more to it than that and I am guessing the qualification process is a lot different to become a GP than it is a Pharmacist.

another thing I dont understand is why like the UK do we not have State GP's where the cost of employing a GP surely has to be cheaper than funding a private doctors fees over a year.

bbsrs

Godge wrote: »

The thing is what if you take the wrong medicine off the shelf? What if there are overdoses of medicines like codeine? The pharmacists are not doctors. Who gets sued? A great idea but in Ireland, the home of the compensation culture, there is a risk.

All medicines come with instructions and precautions. The user should use their brains to decide if its safe for them to take . Why sue anybody if all the info for safe use is available to you.Nanny state.

Annabella1

http://www.independent.ie/national-news/health-minister-james-reilly-orders-investigation-into-flu-jab-error-2946134.html
Pharmacists didnt cover themslves in glory last year!

HellFireClub

A friend of mine is on the dole and has a medical card, he has a stomach ulcer which he has had for as long as I've known him (around 12 years)...

He is on a prescription for the medication, a one a day tablet to keep the ulcer at bay, despite the fact that he will be on this medication for the rest of his life, and has been on it for more than 10 years, he still has to go down to his GP to get a prescription every 3 months!!! He asked if the GP could give him a 6 month prescription or something more suitable for a guy who is on this medication for the long term, surprise surprise, "The HSE says that isn't possible, the longest prescription they can dispense is a 3 month prescription!"...

partyatmygaff

Godge wrote: »

The thing is what if you take the wrong medicine off the shelf? What if there are overdoses of medicines like codeine?

Why would an Rx-only drug be relegated all the way down to self-selection or open sale? If it happens, it'll be treated the same way as codeine (I.e. In the dispensary w/ a clinical interview).

The pharmacists are not doctors. Who gets sued? A great idea but in Ireland, the home of the compensation culture, there is a risk.

Pharmacists aren't doctors and equally doctors aren't pharmacists.

Pharmacists are trained to diagnose common ailments and recognise serious diseases. That forms a small part of their training, the vast majority of their training revolves around pharmacotherapy and drugs.

Doctors are trained to diagnose illness in all its forms and then to figure out a way of treating it whether that be through surgery (Which is their other specialty) or through other treatment methods like drugs. Their knowledge of drugs, while very good has nothing on the knowledge of a pharmacist. It's one thing to do pharmacology for a semester or two and quite another thing to spend four years studying the ins and outs of drugs.

In an ideal world, a doctor would diagnose a patient's condition, decide on a suitable method to treat their condition and then if necessary refer them to the expert in the treatment method they believe would be most effective. If that treatment method involves drugs (As it usually does), the pharmacist decides on the drug and dosing and dispenses the medicine to their patient with the appropriate counseling. That would be the ideal situation but it's not viable unless there's a solid communication link between pharmacists and GPs.

For the time being, it'd make sense to clear up a few inefficiencies surrounding drugs. I'd say one of the biggest burdens on the public system is chronic disease. I see no reason for people with relatively uncomplicated chronic diseases to need to see their GP every month or two for a repeat prescription. It'd make more sense to have pharmacists manage chronic disease and only refer back to the GP in the event of complications or changes in the condition.

Mellio wrote: »

This is the area of diagnosis and your right.

who is going to take on that responsibility of diagnosing you?

I think the pharmasist should have the rights to be able to do this, Im sure there is a lot more to it than that and I am guessing the qualification process is a lot different to become a GP than it is a Pharmacist.

The thing is, pharmacists aren't trained to diagnose to the same extent that a physician is. Equally, physicians aren't trained in drugs to the same extent that a pharmacist is. That's not to say a doctor isn't capable of working with drugs or that a pharmacist isn't capable of diagnosing anything but each profession has its own area of expertise that overlaps a bit with the other.

Mellio

partyatmygaff wrote: »

Why would an Rx-only drug be relegated all the way down to self-selection or open sale? If it happens, it'll be treated the same way as codeine (I.e. In the dispensary w/ a clinical interview).

Pharmacists aren't doctors and equally doctors aren't pharmacists.

Pharmacists are trained to diagnose common ailments and recognise serious diseases. That forms a small part of their training, the vast majority of their training revolves around pharmacotherapy and drugs.

Doctors are trained to diagnose illness in all its forms and then to figure out a way of treating it whether that be through surgery (Which is their other specialty) or through other treatment methods like drugs. Their knowledge of drugs, while very good has nothing on the knowledge of a pharmacist. It's one thing to do pharmacology for a semester or two and quite another thing to spend four years studying the ins and outs of drugs.

In an ideal world, a doctor would diagnose a patient's condition, decide on a suitable method to treat their condition and then if necessary refer them to the expert in the treatment method they believe would be most effective. If that treatment method involves drugs (As it usually does), the pharmacist decides on the drug and dosing and dispenses the medicine to their patient with the appropriate counseling. That would be the ideal situation but it's not viable unless there's a solid communication link between pharmacists and GPs.

For the time being, it'd make sense to clear up a few inefficiencies surrounding drugs. I'd say one of the biggest burdens on the public system is chronic disease. I see no reason for people with relatively uncomplicated chronic diseases to need to see their GP every month or two for a repeat prescription. It'd make more sense to have pharmacists manage chronic disease and only refer back to the GP in the event of complications or changes in the condition.

The thing is, pharmacists aren't trained to diagnose to the same extent that a physician is. Equally, physicians aren't trained in drugs to the same extent that a pharmacist is. That's not to say a doctor isn't capable of working with drugs or that a pharmacist isn't capable of diagnosing anything but each profession has its own area of expertise that overlaps a bit with the other.

So we need to create a new profession and call them pharma-doc.:D

That way we get the best of both worlds, not two professions for one outcome.

lmimmfn

i agree with this, in situations where you know( and where its quire obvious ) what you need, i.e. abscess on your gums or finger is infected and isint healing, why should we be paying 50euro+ for idiot GPs?. When i was living in Paris i could get most things i needed directly from the Pharmacy.

As for it being abused, yes it could be but why not implement something like this for the 0.1% that would abuse it?

partyatmygaff

lmimmfn wrote: »

As for it being abused, yes it could be but why not implement something like this for the 0.1% that would abuse it?

How could it even be abused?

creedp

HellFireClub wrote: »

A friend of mine is on the dole and has a medical card, he has a stomach ulcer which he has had for as long as I've known him (around 12 years)...

He is on a prescription for the medication, a one a day tablet to keep the ulcer at bay, despite the fact that he will be on this medication for the rest of his life, and has been on it for more than 10 years, he still has to go down to his GP to get a prescription every 3 months!!! He asked if the GP could give him a 6 month prescription or something more suitable for a guy who is on this medication for the long term, surprise surprise, "The HSE says that isn't possible, the longest prescription they can dispense is a 3 month prescription!"...

At least your friend dosen't have to pay his GP and 'only' has to contribute €1.50 towards his prescription. Contrast that with a non-medical card holder who will have to cough up €50 - €60 for each GP visit and potentially just under €1,600 a year for the prescribed medication.

HellFireClub

creedp wrote: »

At least your friend dosen't have to pay his GP and 'only' has to contribute €1.50 towards his prescription. Contrast that with a non-medical card holder who will have to cough up €50 - €60 for each GP visit and potentially just under €1,600 a year for the prescribed medication.

The mad thing is, is that when he was paying privately, before he lost his job, his GP could give him a 6 month prescription, which he could generally work into a checkup or a trip for a flu or something like that, but now, because it's the taxpayer who is picking up the tab, it's every 3 months mandatory!!!

Why can the GP issue a 6 month prescription for a privately paying patient, but has to double the number of prescriptions needed and visits required to the GP, when the taxpayer is paying for it?!?!?!?

creedp

HellFireClub wrote: »

The mad thing is, is that when he was paying privately, before he lost his job, his GP could give him a 6 month prescription, which he could generally work into a checkup or a trip for a flu or something like that, but now, because it's the taxpayer who is picking up the tab, it's every 3 months mandatory!!!

Why can the GP issue a 6 month prescription for a privately paying patient, but has to double the number of prescriptions needed and visits required to the GP, when the taxpayer is paying for it?!?!?!?

I think though the extra visits to the GP don't result in any additional cost to the taxpayer as the GP is paid by a fixed capitaiton amount per medical cardholder irrespective of how many times the person visits the GP. This is probably a control measure to stop GPs giving out multiple month prescriptions to medicalcard holders which may result in waste particularly as the GP does not have a prescribing budget and therefore could be incentivised to give out longer prescriptions to stop people coming back for repeat prescriptions in circunstances where GP won't get any additional payment. Unfortunately people with chronic illnesses who require medication on a long-term/premanent basis are caught in the cross fire.

tom_thumb

Godge wrote: »

The thing is what if you take the wrong medicine off the shelf? What if there are overdoses of medicines like codeine? The pharmacists are not doctors. Who gets sued? A great idea but in Ireland, the home of the compensation culture, there is a risk.

pharmacists know more about medicine than most GP,s

nice_guy80

Ah, the Irish Medical Organisation...

promoting a lack of competition, training opportunities and openness in the Irish medical system since the year dot.

Scortho

Annabella1 wrote: »

http://www.independent.ie/national-news/health-minister-james-reilly-orders-investigation-into-flu-jab-error-2946134.html
Pharmacists didnt cover themslves in glory last year!

The problem with the flu jabs was the information provided at the training courses and not actually the pharmacists fault. Most pharmacists
http://www.rte.ie/news/2012/0709/flu-vaccine-risk-review-group.html

partyatmygaff wrote: »

How could it even be abused?

The pharmacist could abuse it by prescribing for the sake of prescribing in order to get more income.

On the subject of the OP yes it does make sense. The idea that a person on the contraceptive pill has to return to her G.P every 6 months to get a prescription is ridiculous especially when the pharmacist is trained to carry out all of the tests any way.

omahaid

Asthma medication is another one. The UK, France and Spain sell ventolin over the counter (I didnt check on any other country, there may be more). Why don't we do the same?

Scortho

omahaid wrote: »

Asthma medication is another one. The UK, France and Spain sell ventolin over the counter (I didnt check on any other country, there may be more). Why don't we do the same?

Medicines classification e.g general sale, pharmacy only or prescription only is set out by the Irish medicines board! If you'd like to direct your anger more info can be got at www.imb.ie

Unfortunately pharmacists can't supply prescription only medicines without prescription unless its an emergency in which case you'd receive the lowest available quantity!

omahaid

Scortho wrote: »

Medicines classification e.g general sale, pharmacy only or prescription only is set out by the Irish medicines board! If you'd like to direct your anger more info can be got at www.imb.ie

Unfortunately pharmacists can't supply prescription only medicines without prescription unless its an emergency in which case you'd receive the lowest available quantity!

To be fair, the IMB is where my anger is aimed. I don't blame pharmacists for this.

L1011

creedp wrote: »

At least your friend dosen't have to pay his GP and 'only' has to contribute €1.50 towards his prescription. Contrast that with a non-medical card holder who will have to cough up €50 - €60 for each GP visit and potentially just under €1,600 a year for the prescribed medication.

The GP could legally give him a 6 month script and most wouldn't charge a full consult for a renewal - probably €15.

Doesn't adjust the nasty bit of the price (I'm going to hazard a guess that its probably Nexium so just under 500 quid a year unless it drops with this IPHA deal) though.

Scortho

MYOB wrote: »

The GP could legally give him a 6 month script and most wouldn't charge a full consult for a renewal - probably €15.

Doesn't adjust the nasty bit of the price (I'm going to hazard a guess that its probably Nexium so just under 500 quid a year unless it drops with this IPHA deal) though.

Which is reliant on the pharmacist passing on the reduction in wholesale price which should be about 10%!
Unfortunately some will and some won't.

L1011

Scortho wrote: »

Which is reliant on the pharmacist passing on the reduction in wholesale price which should be about 10%!
Unfortunately some will and some won't.

Fair few will because they don't know how to change the markup in their software for an individual item :pac:

Scortho

MYOB wrote: »

Fair few will because they don't know how to change the markup in their software for an individual item :pac:

And thats where we need reference pricing to be brought in!
But they've so much more to sort out with the health service before they even get around to touching that!:D