Rural and regional pharmacists need to act now to smoothe the codeine upschedule transition, writes Steven Kastrinakis

From 1 February 2018, medicines containing codeine will no longer be available from pharmacies in Australia without a prescription. The government’s decision to change the way patients can access codeine-containing products will certainly impact a large number of Australians requiring Over-The-Counter (OTC) pain relief. In particular, the changes may impact rural and regional communities to a greater extent.

According to the Australian Bureau of Statistics – Regional Population Growth 2016, over 2.5 million Australians reside in the outer regional, remote, and very remote areas of Australia. More importantly, data from the 2017 Social Health Atlas of Australia indicates that around 2.4 in 100 adults living outside of the greater capital city and major urban centres experience a barrier to accessing healthcare when needed, with the main reason being cost of service.

I’ve spent time discussing the upcoming changes with our members whose communities will be most impacted by these changes. Talking to Iain Cartney, our pharmacist in the regional Victorian country town of Bairnsdale, he anticipates that the codeine up-scheduling will put more pressure on the already congested medical system in his community.

“The waiting time for GP appointments at the two main clinics here in Bairnsdale is currently around six to eight weeks – and that’s for existing patients,” he says.

It is also known that this congestion has often resulted in the clinics being unable to accept new patients, and the problem may be exacerbated with the codeine up-scheduling. Patients would thus be required to access GPs from out of town, causing extreme inconvenience particularly for elderly patients living in rural and regional communities.

Sandra from the Advantage Pharmacy in Mirani, QLD also shares similar views, as access to GPs is scarce despite the relatively small population in Mirani. As a pharmacist that’s deeply embedded in the community, Sandra also notes that the up-scheduling will have financial impacts on those requiring a prescription for codeine-containing medications.

“The clinics here only allows bulk billing for selective patients, so many of those in our community will have to pay quite a hefty fee to see a GP for something that they previously did not have to,” she says.

In rural and regional areas, as access to GPs is often limited, Emergency Departments (ED) and Urgent Care Centres (UCC) can get inundated with non-urgent cases which can otherwise be handled by primary healthcare providers in the community setting.

Data from the Australian Institute of Health and Welfare: Emergency Department Care 2015-16 shows that the proportion of non-urgent cases presenting to ED is considerably higher in the outer regional, remote and very remote areas of Australia compared to major cities and inner regional areas.

Triage Category

Remoteness area of usual residence

Major cities

Inner regional

Outer regional

Remote

Very remote

Resuscitation

1%

1%

1%

1%

1%

Emergency

13%

10%

10%

8%

9%

Urgent

38%

34%

32%

27%

29%

Semi-urgent

41%

43%

43%

48%

45%

Non-urgent

7%

12%

14%

16%

17%

Clearly, there are already some pressures placed on hospital EDs in rural and regional areas, and as of 1 February there may be some increase in demand due to non-urgent cases for pain management.

Steven Kastrinakis.

A large proportion of our network of pharmacies are located in rural and regional areas of Australia, and we are proud to be able to serve local communities for their health needs. Our pharmacists’ role in these areas is particularly critical in this period leading up to the 1 February changes, for the provision of patient education and guidance in navigating the system changes.

There is no doubt that we will see some confusion, anger and even backlash from the community regarding the up-scheduling.

As pharmacists, we need to proactively counsel patients and perhaps do some pre-screening prior to the 1 February changes.

Our role as pharmacists in this regard, is to ensure that there won’t be a sudden rush when the change occurs, and help ease the burden on primary healthcare providers. This can be achieved in many ways such as good inventory management, supply of accurate and up-to-date information and references to facilitate the conversation with people in the community.

Steven Kastrinakis is the CEO of Advantage Pharmacy Group. The Advantage Pharmacy Group is a leading banner group with a growing number of independently owned and operated pharmacies made up of over 150 community pharmacies across Australia. Membership has grown over 100 per cent in the past twelve months and is expecting continued strong growth throughout Australia as pharmacists seek a truly independent group to align with to support their business.

http://advantagepharmacy.com.au/