Working together: Brad & Sudheer

In the first instalment of our series on pharmacist collaboration with other health practitioners, we speak with a Canberra pharmacist and doctor about how they work together

Almost every week it seems doctor and pharmacist groups are battling it out over roles and funding, with jabs being taken on both sides.

But what’s really happening on the ground?

Pharmacists and doctors work together in a variety of complementary ways when looking after patient health.

Bradley Butt, Managing Partner at Cooleman Court Pharmacy in Weston Creek, ACT, says he communicates with the local GPs on a regular basis.

The greatest area of collaboration with the local doctors relates to the management of Dose Administration Aid (DAA) patients, he tells AJP.

“We’ve got a couple hundred DAA patients that we’re in regular contact with the doctors over. It’s important to note that this relationship for these patients actually goes beyond just requesting a script and the doctor writing it.

“It’s also about reconciling medication charts, identifying compliance or medication interaction issues, working to liaise with the doctor when a patient’s been discharged from hospital, what changes might have occurred and which prescription might be needed, and arranging Home Medication Reviews (HMRs) with the GP, so that we can offer the patients an opportunity to learn more about their medication,” says Mr Butt.

“Outside of DAA patients, we work fairly closely with the local GPs on things like influenza vaccination, Boostrix – the immunisation offerings that pharmacies can now do.”

Mr Butt says the vaccination services have been “well received” by the doctors.

“We’ve got a fairly collaborative approach with the GPs in that we’ve always been on the front foot with them, open and honest about our intentions with vaccination with them,” he says.

“We’ve helped them realise that we’re not taking their patients and their revenue, but we’re probably opening up the market a little bit more so the patients who were doing vaccinations were patients that may not have seen the doctor anyway.”

He said some of the GPs had concerns that the vaccinations were being done unprofessionally, for example in the staff kitchen room, and that the pharmacy might not be able to manage anaphylaxis.

“Our pharmacy is a brand spanker, we’ve got consult rooms and everything’s done really professionally. I think we’ve been able to break that down and show them that no, we’re actually delivering it in a very highly professional setting and the patient is getting good service, and the GPs are being kept abreast as to what’s going on as well,” says Mr Butt.

“We used to send them the reports for their patients that had been vaccinated, but now with the online immunisation register we upload to that and that’s got full access to what we’re providing.

“Sometimes they can disagree with you and that’s cool. Generally it’s pretty positive and they’re appreciative of it and they recognise us as an integral part of the healthcare team.”

“I think being able to utilise the technology has been beneficial to us, that we can demonstrate to the GPs that we’re not just pharmacists putting a sticker on a box, we’re actually stepping beyond that line and [working to] our full scope of ability.”

Not only did he manage to allay their fears, but some of the GPs subsequently got their vaccinations from the pharmacy as well.

“It’s been really good and well received, and certainly we’ve invited them to come down and look at our pharmacy – we’ve vaccinated a few of the doctors here. I think if a pharmacist is able to do that it’s a really great way of showing the doctors what service you can deliver and how you’re doing it.”

Mr Butt explains that the local GP registrars spend time in the pharmacy to see what the pharmacists do and what kind of medicines they can prescribe.

“We’ve seen as a result of that the junior doctors, the registrars will often call up and they want to know, what do you suggest we use for an uncomplicated vaginal thrush? What’s the current recommendation? We get a bit of that from those junior doctors which I think is really wonderful.”

The local GPs also refer patients to the men’s health clinic at Cooleman Court Pharmacy for issues such as erection dysfunction, prostate cancer, premature ejaculation and Peyronie’s disease.

“GPs might only have 4-5 patients with erection dysfunction or prostate cancer at any one time, so it’s hard for them to be entirely across what’s happening in that space,” says Mr Butt.

“So a lot of the local GPs refer to us to find out what to best use in a patient, and equally the urologists and hospitals refer to us.”

In general pharmacists and GPs get along quite well, says Mr Butt.

“Sometimes they can disagree with you and that’s cool. Generally it’s pretty positive and they’re appreciative of it and they recognise us as an integral part of the healthcare team,” he says.

“It’s not even that we’re always going to them with questions, sometimes they’ll be coming to us with questions.

“You’ll get doctors who are really engaged and proactive, and you’ll get doctors who are less engaged and proactive … and some of them just don’t like pharmacists – there’s certainly doctors out there who say pharmacists are just part of the supply chain and they’re making all the money.”

However he says that’s never been his personal experience.

“I’ve been here 10 years and prior to my time here I was out in the bush, out in Armidale in northern NSW. We always found that the doctors’ and pharmacists’ relationship was very good as a collective.”

Dr Sudheer Gudipalli, a GP at Weston Creek Family Medicine, ACT, and a Fellow of the Royal Australian College of General Practitioners, says he has a “very good relationship” with the local pharmacists in his area.

He says collaboration is imperative because the pharmacist helps to identify interactions, double ups and undisclosed allergies.

“Sometimes there will be some sort of interaction between these medications, the pharmacist can come back and alert us. Sometimes the patient goes to multiple doctors and they all go to one chemist, so he will have a whole list of [the patient’s] medications in some cases,” Dr Gudipalli.

“If this new script coming in may interact with the previous medication that a patient is on, they do a great job of ringing the doctor and alerting them: are you sure you are aware that this person is on this medication, do you want us to go ahead or do you want us to hold? And that’s a very useful thing.”

Patients can also forget to tell the doctor that they are allergic to a particular drug, such as an antibiotic.

“But the chemist picks it up and alerts us immediately, saying he is allergic to it, do you want to continue it? It’s sort of working together, wanting to prevent complications,” Dr Gudipalli tells AJP.

“Sometimes patients present to the chemist saying, ‘we have this problem’ but they think that it’s not big enough to go to the doctor. But the chemist picks it up and says, ‘no, no, that problem is important to go and check with the doctor’ and they sometimes divert them to come and see us for that problem which is easily fixable with medication. Instead of the patient thinking, ‘this is something that I just have to put up with’.

“It’s a team thing. It improves the healthcare to prevent complications due to medication and it controls polypharmacy.

“In a way that is the biggest problem in the community at the moment, people are going to multiple places, picking up medication and adding to it. If the person comes to the doctor, they feel like they have to give some medication to them – they add. And the patient goes to another doctor – they add.

“And so all these additions brings up multiple medications for the patient and that’s called polypharmacy. We always request the care pharmacist to review all a patient’s medication to see if we can control the polypharmacy problem.”

“It should be a ‘working together’ kind of relationship rather than thinking that you are more important or that I am more important – it is a team. Everybody has to respect a person’s role.”

Dr Gudipalli says medication reviews are crucial.

“Personally I use pharmacists quite a lot in reviewing medication because the chemist goes to the home and checks what they are actually taking. A patient can come into my room and tell me they are taking this or that, he thinks that it’s this medication but it’s different. They have the same medication with two different names, so they think they are two different medications and they keep taking them [both],” he explains.

“We come across this in the elderly population quite significantly. That is why everybody who is taking more than four or five drugs, I feel it is very important to have a medication review, to see how they are taking their medications, if they are taking them in the right way, or if there is any doubling up of the medication or administration problems.

“Sometimes they take the script and they can’t swallow, but they don’t tell us and they just don’t take it.

“So the chemist goes to their home and reviews their medication and reviews the way they are taking the medication.

“Errors can be possible because patients go to specialists, they go to the doctor, they go to the hospital – everybody changes, and the system is not as transparent as we think,” says Dr Gudipalli.

“Even one problem, one patient affected is a significant problem for us, I look at it in that way. We always take the help of the chemist to control this issue.”

Dr Gudipalli says pharmacists and doctors generally get along in a professional sense, and any conflicts are mostly due to personality clashes.

“Personally I work together in a team with pharmacists, we respect each other’s role, their role is their role and my role is my role.

“We see these clashes between the pharmacists and doctors and that is more of a personality dependent thing rather than professionally – that combination works much, much better for the better care of the patient.

“I think it is a good idea, and it should be a ‘working together’ kind of relationship rather than thinking that you are more important or that I am more important – it is a team. Everybody has to respect a person’s role and in that way it will work better.”

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