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30 November 2015

There are calls for pharmacists to play a bigger role in supporting self-care. George Tambassis, National President of the Pharmacy Guild of Australia, and GP Kean-Seng Lim discuss the opportunities.

A recent report from strategic policy institute Global Access Partners recommends that pharmacies play a bigger role in delivering primary health care, promoting health literacy and supporting responsible self-care. It also notes that a ‘pharmacy first’ policy for short-term, self-limiting ailments would give general practitioners (GPs) and hospital emergency departments time to focus on more serious cases.

“We’ve identified a number of services that pharmacies could provide or extend that would benefit patients and also take some pressure off their doctors,” says George Tambassis, National President of the Pharmacy Guild of Australia. “Medication management is an obvious one, such as providing emergency prescription refills and prescribing medication for minor ailments. Pharmacists are also well placed to order and interpret laboratory results and administer vaccinations by injection. These services aren’t new or untested – they’re all readily available in many British, American and Canadian pharmacies.”

A question of funding

In Australia, lack of clarity around funding is a major barrier to progress.

“Services cost money to deliver, and there are just three ways for a pharmacist to be paid – by the patient, the government or private health insurance,” Tambassis continues. “We’re seeing a gradual increase in the number of services covered by private health funds as they recognise that pharmacists can reduce their costs by helping to keep people out of hospital.”

This year’s Sixth Community Pharmacy Agreement provided $1.26 billion in funding for community pharmacy programs over the next five years. This includes a $50 million Pharmacy Trial Program to pilot a range of new patient services designed to enhance pharmacies’ primary health care role.

“At the moment, funding for both new and well-established programs is generally for people entitled to some form of concession,” says Tambassis. “The proposed model of increased care can only be sustainable if we establish a fair price for providing extra services to the general public and ensure the right person or entity is footing the bill.”

Part of the practice

The Australian Medical Association (AMA) recently released a proposal to make non-dispensing pharmacists key members of the general practice health care team. Mt Druitt Medical Centre has already taken the initiative – Clinical Pharmacist Radhika Somasundaram has been working in the practice for over a year.

“Clinical Pharmacists are independent professionals working as part of an integrated team,”says Dr Kean-Seng Lim, one of the medical centre’s five GPs and the 2015 Royal Australian College of General Practitioners’ GP of the Year. “This is still quite unusual in Australia but it’s quite common in the United Kingdom and the United States. One of the great strengths of the non-dispensing pharmacist model is that it separates potential conflicts of interest and builds on the benefits of integrated care. This is not about substituting one professional for another, but establishing partnerships that improve the quality of care received by the patient as they reduce the total health spend.”

Lim has no doubt that pharmacists can make a valuable contribution to primary care.

“They’re highly trained professionals whose skills complement those of most doctors,” he says. “I believe it’s a natural partnership with the potential to provide more comprehensive treatment to patients and extra support for their self-managed care.”

Somasundaram provides support in a number of ways.

“She can identify patients who are at risk and ensure they are regularly reviewed,” says Dr Lim. “This includes people who are taking many different medications or certain combinations of medications, who are over a certain age or who have difficulty with compliance. For example, someone with severe arthritis might struggle to open a blister pack or bottle with a childproof lid.

“She can optimise medication for people with chronic illnesses such as diabetes, asthma and heart disease. When we did an analysis of the first 50 patients she had worked with we found that many had been able to reduce the amount of medication they were taking quite substantially. She also provides face-to-face education and is available to answer questions about medication that don’t need to be run past a doctor.”

An integrated team

Again, funding is a limiting factor in developing an integrated team.

“This is very frustrating because an independent analysis from Deloitte Access Economics shows that the AMA’s proposal delivers a benefit-cost ratio of 1.56, which means that every $1 invested in the program generates $1.56 in savings to the health system,” says Dr Lim.

There are also some GPs who are unaware of the level of assistance a pharmacist can provide.

“We have found that once pharmacists and GPs have an opportunity to talk to each other, they very quickly see the synergies and potential benefits,” says Dr Lim. “Integration is the key factor. Health professionals who are working together with common aims and access to the same information are in the best position to help patients manage their own care.”

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