How could pharmacists help provide services which are scant in rural areas? wonders Karalyn Huxhagen
Since the third community pharmacy agreement, the focus has been on developing professional programs including interprofessional collaboration and working within teams of primary health care.
What happens when the community pharmacy and the home and community care (HACC) nurses are the only consistent health providers in the community? Where do all of those ’extras’ that we are supposed to refer to come from?
For some communities there are fly-in, fly-out services such as Diabetes Educators, women’s health service, ophthalmologist, surgeons and so on. What about the grass root services for pain management such as massage, physiotherapy, Tai Chi, Pilates, water based exercise programs.
Where do these come from? Where do we access pulmonary rehab programs? Cardiac care programs? Mindfulness programs?
Many years ago when Health Workforce Australia was formed I was part of a think tank looking at how to better equip pharmacists to work in rural and remote Australia. There was a lot of discussion of upskilling pharmacists working in these areas to be able to provide immunisation, cannulation and advanced wound care.
They would also be able to follow set programs within the scope of prescribing under the Primary Health Manual, CARPA manual or similar. These activities would be undertaken under guidance from a practitioner to enable provision of ongoing therapy to patients.
In my recent travels I have encountered a desperate need for programs for pain management and management of chronic obstructive airways disease. Programs needed in these communities include therapeutic massage, pulmonary rehabilitation, water based exercise programs, mindfulness, cognitive behavioural therapy, Pilates and Tai Chi to name a few.
Basic mental health first aid and base line psychology programs are badly needed.
Having these providers available in the community is very difficult. At best the practitioners will visit on a rotating basis.
Is there a place for pharmacists and pharmacy staff to become upskilled to provide ongoing care programs for areas such as pulmonary rehabilitation? Is there funding at a primary health level for delivering these programs through a pharmacy environment?
I note that many of the QCPP Pharmacies of the Year do provide extended programs in areas such as smoking cessation, sleep apnoea and mental health. The scope of delivery in rural and remote Australia is beyond our regular programs.
How would these programs be funded? How do we work with other providers e.g. the HACC nurses to provide these programs?
I am often asked by the HACC nurses to provide education to them about medications to enable them to be able to make informed decisions when working in these rural and remote locations. I am proposing that pharmacy could be upskilled by other providers to be a support network to continue programs under guidance from another practitioner.
What other alternatives are available? Can we use telehealth with the pharmacist as the coordinator to enable patients to do their pulmonary rehab exercises by skype or telehealth?
There is a wide scope of opportunity to be explored within these questions.
If the pharmacy establishes such programs and then an actual practitioner moves into the location how will this be managed? If the pharmacy has invested in training, facilities and equipment to provide ongoing rehabilitation programs and then a physiotherapy sets up an establishment within the town how will these dynamics be managed?
This is all food for thought. Pharmacists are located in these towns and could upskill if they are willing… and have the time. There does need to be a balance between being too committed and not having a life!
Karalyn Huxhagen is a community pharmacist and was 2010 Pharmaceutical Society of Australia Pharmacist of the Year. She has been named winner of the 2015 PSA Award for Quality Use of Medicines in Pain Management and is group facilitator of the Mackay Pain Support Group.