‘There is a lot we can do.’

AJP chats with award-winner Dr Manya Angley, who says her lived experience as a carer ignited her passion for people with intellectual and developmental disability

Dr Manya Angley was announced as the 2021 Australian Association of Consultant Pharmacy (AACP) MIMS Consultant Pharmacist of the Year at ConPharm in Adelaide last weekend.

Dr Angley, who has been accredited with the AACP since 2010 and runs her own consultancy, Manya Angley Research and Consulting (MARAC), was recognised for her medication safety advocacy for people living with disabilities.

In September 2020, she provided powerful testimony to the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability where she spoke of issues with inappropriate use of medicines.

AJP asked Dr Angley about the win and her journey to where she is today.

How do you feel being recognised as the Consultant Pharmacist of the Year for 2021?

I am absolutely thrilled to receive the AACP MIMS Consultant Pharmacist of the Year Award. I feel very honoured and humbled, particularly given the line-up of past recipients but also acknowledging the many unsung heroes who are consistently providing ‘top drawer’ consultant pharmacy services – I am inspired by these folks too.

I am grateful to have had outstanding mentorship along my journey, which started with Lloyd Sansom and Andy Gilbert when I was an early career researcher at UniSA in the 1990s and I worked on the Pharmacy Guild-funded Model Practice project which laid the scaffolding for the RMMR and HMR programs we have today.

I have also had the privilege of mentors like Debbie Rigby, whose encouragement to get out of one’s comfort zone and be brave has been invaluable. Deb has also modelled tenacity: when you don’t immediately achieve your goals regarding something you are passionate about, it’s back to the drawing board. Talk to people, gather more information and change tack with your approach. It’s about focusing on the common goal – the best health outcomes for our patients.

I also have learnt so much from the students I have taught over the years, the GPs I work with in general practice, and the nurses, allied health professionals and other staff in the aged care homes I service.

My steepest learning curve has been accompanying loved ones on their ‘health journey’ as primary carer. My lived experience as a carer has certainly ignited and sustained my passion for striving for best care for people with intellectual and developmental disability, dementia and those who are palliative.

Growing up in the “outback” means I’m also passionate about improving health care services in rural and remote Australia.

While it is tremendous to receive this ‘gong’, most importantly it shines a light of the potential benefits of consultant pharmacists having enhanced opportunities to address the gaps that exist in providing best care for these people.

What personal and career steps led to you into your current position of advocating for people with disabilities?

My sister had Down syndrome and died prematurely aged 46 with dementia, and I have a 24-year-old son with autism and intellectual disability who still lives at home. Both have inspired my current position.

When I returned to academia in 2004, after a period of parenting leave, I established the Autism Research Group (ARG) which was an interdisciplinary group of researchers. Our research focused on developing a laboratory test to diagnose autism and quality use of conventional and complementary medicines in autism.

I became particularly interested in the overuse of misuse and overuse of antipsychotics in young people generally, and an audit revealed many of these were youngsters with intellectual and developmental disability.

Antipsychotics are powerful medicines and have a myriad of serious adverse effects, plus there is limited evidence for efficacy in managing behaviours of concern. After leaving academia in 2010, I became accredited to conduct medication reviews and was naturally drawn to conducting medication reviews for people with intellectual disability.

As I also work in aged care, it became evident that the issues with chemical restraint highlighted through the Aged Care Royal Commission were at least as much of a problem in the disability sector where there is less regulation and oversight and there is a dearth of linked data and research generally.

It was also evident that accredited pharmacists shy away from this sort of work, likely because they lack the skills and confidence, plus medication reviews are especially complex and time consuming. Presented with the opportunity to be a witness at the Disability Royal Commission, I felt morally obliged to share my professional experiences.

How can pharmacists do more in this area?

I would encourage pharmacists to embrace opportunities to upskill to increase their confidence when providing care to people with intellectual and developmental disability. Improve your skills to better understand their health care needs and how to best interact with them, especially those with complex communication needs.

Given the complexities, it is crucial that strong interprofessional relationships are forged across both the health and disability sectors. Be proactive, get in touch with local disability providers and let them know about medication reviews and how they can trigger the process. Let disability sector professionals know that medication reviews can be tailored to meet the needs of a range of clients and the staff that support them.

Now that accredited pharmacists can provide up to two follow-ups after the initial medication review i.e. a cycle of care, the benefits of the service are potentially much greater and we are well positioned to promote and support deprescribing as well as monitoring of physical health and adverse effects.

There is a lot we can do to reduce the current inequities in health care for these people. It is a very rewarding area of my practice.

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