AMA advocating for non-dispensing pharmacists


doctor pharmacist collaboration consultation pharmacists in general practice GP

Evidence is accumulating to support the “valuable” role pharmacists can play when integrated into the general practice team, a leading doctor says

Dr Richard Kidd, chair of the AMA’s Council of General Practice, has penned a piece in Australian Medicine outlining how general practice can bring “pharmacists into the fold”.

“It has been almost three years since the AMA put forward its proposal to make non-dispensing pharmacists a key part of the future general practice healthcare team,” writes Dr Kidd, saying that “our advocacy on this issue has not wavered”.

General practice pharmacists would enhance medication management and reduce hospitalisations from adverse drug events, he says.

“An independent analysis from Deloitte Access Economics (DAE), which was released with the AMA’s proposal, showed that integrating pharmacists into general practice would deliver a benefit-cost ratio of 1.56,” writes Dr Kidd.

“If general practices were supported to employ non-dispensing pharmacists as part of their healthcare team, they would be able deliver real cost savings to the health system, of $1.56 for every dollar invested.

“An in-house pharmacist would be able to assist GPs address overprescribing and medication non-adherence by patients.

“We would see better coordination of patient care, improved prescribing, improved medication use, and fewer medication-related problems. Hospitalisation rates from ADEs would fall and our patients’ quality of life would be improved as would their health outcomes.”

Dr Kidd cites research recently published in the International Journal of Clinical Pharmacy, which found that when pharmacists work within a general practice their recommendations are more readily accepted by GPs at that practice.

He says this supports 2013 research entitled ‘An evaluation of medication review reports across different settings’, in which findings were similar.

In this research, when pharmacists conducting a medication review had access to the patients’ medical file and the relevant clinical information in them, their recommendations were more targeted and less conjectural.

“With chronic disease on the rise, and an ageing population, it is estimated that there are more than 700,000 patients with co-morbidities who would benefit from a review of their medications,” Dr Kidd writes.

“This figure represents just the top 10% of patients who could benefit from having their medications reviewed. In-house pharmacists could be a valuable resource for patients in understanding their medications and how to use them.

“With over 230,000 medication related admissions to hospitals every year at a cost of $1.2 billion per annum and patient medication non-compliances estimated at 33%, the time has well and truly come for action on this front.”

The AMA Council of General Practice is looking forward to the upcoming interim results of another trial, looking at non-dispensing pharmacists in 14 medical centres in greater Brisbane, he says.

“With increasing evidence that where pharmacists are integrated within general practice patient care is improved, the AMA continues to advocate for Government funding to make this an everyday reality for general practice and for patients,” writes Dr Kidd.

PSA national president Shane Jackson welcomed the piece on Twitter.

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15 Comments

  1. Greg Kyle
    13/04/2018

    While this is a positive step, the talk is still about “employment”, not having pharmacists as practitioners! Any employment is legally based on the “master-servant” relationship, meaning in this case, GPs will be able to dictate what pharmacists can & can’t do, regardless of professional scope of practice. I believe our professional bodies really dropped the ball on this one and sold out practitioner status for pharmacists (like physios, dieticians, nurse practitioners and other allied health professionals) to get a “quick win” through taking the “easy road” with medical politics.

    • Jarrod McMaugh
      13/04/2018

      Greg, there is no doubt that AMA’s position on it would be for an unbalanced professional relationship – that would explain the use of the terminology “into the fold” as if pharmacists working in community or hospital now are wildly galavanting around the health industry….. but that’s a long way from the position of any pharmacy organisation, or a bipartisan model for these roles.

      Realistically, until Medicare gives pharmacists provider numbers, the only funding model is as a salaried professional who is funded through private fees, a government PIP, or as an expense of the practice. One way or the other, pharmacists in GP will be an employee…. but it’s hardly a “master-servant” relationship – most of us are employees…. including academics.

      • Anne Develin
        13/04/2018

        Agree with your second para Jarrod..

        Master servant relationship is an incredibly negative way of looking at this. As a ‘salaried’ pharmacist in General Practice as part of the ACT pilot my professional autonomy is in tact and I am in no way a servant to anyone – Just doing the best thing for our patients along with our dieticians, psychologists, GPs, exercise physiologists, nurses and nurse practitioners… and soon podiatrists who are joining the practice – ALL employees!. How is the employment status of a pharmacist in General Practice any different to one employed by a community pharmacy owner…? No matter the location of pharmacist services or the funding model, should we not be focussing our attention on the potential benefits to patients.

        • Ron Batagol
          13/04/2018

          Agree-got to have pharmacist recognition as skilled and qualified independent Medicare-accredited provider!!

        • GlassCeiling
          13/04/2018

          We should always focus on patient benefit .

          You will find that podiatrists, nurse practitioners, exercise physiologists , dietitians have provider numbers and therefore autonomy in professional and financial arrangements.

          Practice nurses are generally poorly paid in general practice due to lack of provider status and so too will salaried pharmacists be poorly remunerated unless we are paid by item number and negotiate with GPs from there. There will always be people willing to work for peanuts and that sets the standard for salaried GP practice remuneration. PIP are never a cost recovery payment.

          Getting it right from the start is crucial as the choice between poorly remunerated dispensing employee pharmacist or poorly remunerated clinical pharmacist will continue the exodus of registered pharmacists .

          • Anne Develin
            13/04/2018

            Lack of a provider number does not necessarily mean lack of autonomy. This has been my experience anyway. Emotive language such as ‘Master-Servant’ relationship between GP and Pharmacist is unhelpful in my view.

    • GlassCeiling
      13/04/2018

      Story of our professional bodies – selling out

  2. Andrew
    13/04/2018

    A provider number and fee for service for every pharmacist would be great but it’s not compatible with the current structure. The Guild won’t surrender any part of the CPA rivers of gold and will fight tooth and nail any attempt to diversify from the commercially-driven model. There’s structural issues that have prevented any kind of innovation or diversification in the past 25 years and they’re likely to continue as per the status quo.

    If we look at the evidence for actually improving people’s health it seems more and more it is pointing to pharmacist activities outside of the retail pharmacy. HMRs, nursing homes, non-dispensing at GP practices, hospital wards of all kinds, clinical teams….. there’s a good amount out there to show actual real-world benefit and health-system efficiencies. There’s not nearly as much evidence to support retail pharmacy activities and what does exist is only in the trial stage and has been funded at the expense of (or in preference) to the proven services.

    Pharmacy should be able to demonstrate to policymakers that it can achieve the kinds of health outcomes it has talked itself up about for years. Retail pharmacy is seriously lacking in this area compared to other services, despite receiving the bulk of the funding, political clout, and focus of peak bodies. Show us some outcomes.

    • Anne Develin
      13/04/2018

      Totally Agree Andrew…

    • United we stand
      13/04/2018

      So right it hurts right in the feels

    • Nom
      14/04/2018

      Well, I’d like to look at it from a more positive view – one simple reason being the political support from the medical fraternity. One can never over-state what this means for pharmacy – to have peak medical body(-ies) on our side.

      Secondly, *IF* the professional bodies in pharmacy (e.g. PSA, SHPA) get it right, i.e. INDEPENDENT funding model away from the CPA, then we may have a fair to good chance of this happening. Frankly I can’t see how the Guild can stop it that way, seeing that the pharmacists will be practicing as sole-practitioners and not beholden to any affiliate pharmacy or pharmacy proprietor(s).

      Fingers crossed!

  3. JimT
    13/04/2018

    quote”until Medicare gives pharmacists provider numbers” now that’s a statement that needs to be brought up a lot more times. All our people of influence in the PSA and PGA as well as pharmacy academics and every pharmacists out there who should be lobbying their local member anyway with elections coming up in State and Federal levels. This conversations has to be given legs and we must all run with it and run hard…

    • United we stand
      13/04/2018

      There is no incentive for the guild to work on that front unfortunately

      • JimT
        14/04/2018

        It would be interesting to see a reply from PGA and PSA on this ??

  4. Steve Cohen
    16/04/2018

    The best opportunity ever for pharmacists to especially assist the gp’s disadvantaged patients eg if visually impaired, ESL, indigenous etc to reduce adverse Drug Events. This would work by demonstrating to them, or their carers, how to download and use the free Our Pills Talk Medication Safety App Ref qr barcode pharmacy-generated sample labels: OurPillsTalk.com.au
    Value-added to the GP’s practice

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