Could other providers upskill rural pharmacists?

rural pharmacy: pretty rural scene with gum trees and blue sky

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.


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  1. PeterC

    Brilliant suggestions Karalyn. My thoughts have been running along similar lines for a few years now. after increasingly finding that A. the established community pharmacy ‘specialties’ go nowhere needing the actual needs of my remote rural community and B. the output of some services that do exist in my community, for example the local wound care clinic, often seems substandard.

    In rural areas, local health care services often revolve around the local State government hospital and health service. State Health is appallingly bad (in NSW at least) at engaging with clinicians who aren’t actually employed by it and often lacks the imagination, lateral thinking capacity and local decision-making power to effectively respond to opportunities. On top of that, community pharmacy has historically been left out of GP collab-cares and the like, and that has led to us being ever so slightly ‘out-of-sight, out-of-mind’.

    In my opinion, it will require some sort of concerted campaign by our leaders to turn it around – and it would be money well invested, because it would do more to establish pharmacy as mainstream primary care than a dozen PTPs, with benefits back to the profession as a whole – but I worry that their focus is elsewhere.

    With massage therapy and the like, the situation is similar as for pharmacy. My wife is a well-qualified and -experienced massage therapist (note to all single people: marry a massage therapist) who in Canberra received many referrals from GPs and physios, but out here – while she is recognised as a potentially valuable community resource – no-one in the health system can imagine how they would actually go about doing that. There simply is no clinical referral pathway.

  2. Maxine Mccullough

    All well and good to upskill these pharmacists but when you are the sole pharmacist in a rural area where do you find the time?????? Most can’t afford to hire another pharmacist to be on the floor whilst you are providing professional services that are already available. Too many hats!!!!!

    • Karalyn Huxhagen

      I agree time management is an issue but it can be managed. One community I worked in I was community and hospital pharmacist. When I was at the hospital the phcy was still open under the control of the phcy assistant and we had clear delineation of what could be undertaken while I was absent. My point is that the services I was proposing are not available and as Peter said Govt funded programs do not consider pcists as a provider when developing programs.

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